Distributing intranasal naloxone in rural communities: Implementation of a novel approach

Opioid-related overdose deaths have risen sharply in rural areas of the United States during the past decade. Intranasal naloxone (IN) can reverse the effects of opioid overdose if given promptly. However, access to IN is often hampered by cost, availability, and stigma. Dispensing IN in vending machines (VMs) offers a means of addressing these barriers and increasing the availability of this form of overdose prevention for the general public in rural communities. From September 2022 to December 2024, the University of Vermont Center on Rural Addiction undertook a descriptive exploratory multi-site intranasal naloxone vending machine (INVM) implementation project, partnering with five organizations in underserved rural areas throughout northern New England. In this report, we describe our stepwise approach to site selection, machine design and installation, community relations, and data collection and monitoring that we developed to facilitate program implementation. Monthly total IN doses dispensed per machine typically peaked in the first month after installation (mean 131; range 44–226) and subsequently averaged 47 (range 10–98) doses per month, with 19.3% of doses dispensed on weekends, and 49.5% occurring outside of business hours. Concerns voiced by rural community members in response to the anticipated placement of a VM were addressed by engagement with stakeholders and communication of facts about IN. Overall, these results suggest that VM-based naloxone distribution is feasible in rural communities and holds substantial potential for addressing opioid-related harm in these hard-hit areas.