Using naloxone saturation measures and opioid overdose burden to optimize geographic distribution of naloxone in Rhode Island.

OBJECTIVES: To describe the geographic distribution of naloxone kits in Rhode Island using multiple measures of naloxone saturation to inform future naloxone distribution efforts. METHODS: Naloxone distribution by region from 2022 to 2024 was compared by kits dispensed per fatal overdose, per non-fatal overdose, and per 100,000 residents using data on naloxone kits distributed by community-based organizations in Rhode Island. These measures were also compared to the published PROFOUND model estimates which provide naloxone distribution guidelines using a demand-based approach that prioritizes distribution to areas where people are at greatest risk of opioid overdose. This study defined naloxone saturation as a region having higher than the statewide ratio for non-fatal/fatal overdose, kits per 100,000 residents, or the PROFOUND recommendation for the region. RESULTS: From 2022 to 2024, community-based agencies distributed 124,606 naloxone kits. Across the four measures, disparities in geographic distribution were similar, however, naloxone distribution by overdose burden varied widely. Regions with a higher burden of overdoses generally had higher naloxone distribution; however, distribution varied substantially across the state, even among regions with similar overdose burden. Three of Rhode Island's ten regions consistently had the lowest naloxone distribution among all four measures and were selected for interventions to increase distribution. CONCLUSIONS: Public health jurisdictions can explore geographic gaps in naloxone kit distribution to help ensure equitable distribution of naloxone and identify areas to increase distribution efforts.