Staff Perspective: Who Can? We Can. Narcan! PART III: Medicine and Public Health
Not All Superheroes Wear Capes, Some Wear Lab Coats
Short and Long-Term Medicinal Treatment of Physical and Psychological Dependence
Parts I and II explored how opioids act on the brain and how American history — particularly its wars — helped fuel cycles of addiction. Now, we turn to the present. This final installment of “Who Can? We Can, Narcan!” focuses on the lifesaving tools that can interrupt that cycle, from medication-assisted treatment to emergency overdose reversal. In the military and veteran communities, where resilience is both a strength and a barrier to care, these interventions are transforming how we talk about and respond to overdose risk.
During the Vietnam-Era epidemic, researchers were searching for ways to counter opioids’ destructive effects (Payte, 1991). This research resulted in two distinct trajectories, each with different medications and goals. One path focused on helping people overcome opioid dependence, leading to the development of agonist substitution treatment—a long-term method for addressing addiction by substituting a more potent full agonist opioid with a less potent opioid (i.e., levomethadyl acetate, buprenorphine, and methadone; Johnson et al., 2000). It also resulted in the development of a long-acting opioid antagonist that blocks opioid receptors, preventing opioid agonists from plugging back in and reducing relapse risk (Naltrexone; Kirchmayer et al., 2002). Because of how it works, Naltrexone is only given to patients who do not have opioids in their system–typically individuals who are in early recovery or who have completed the detoxification process (Sullivan et al., 2007). While each of these medications has risks and benefits, they share one thing in common: they are all important tools in the fight for sustained recovery (Volkow et al., 2019).
Naloxone to The Rescue!
Emergency Intervention
So we have powerful, if underutilized, weapons to help in the long-term treatment of opioid use disorder. But how do we decrease opioid overdose deaths in people who may not yet be in recovery or who unwittingly ingest a high-potency opioid? In the event of an overdose, the use of methadone, buprenorphine, or naltrexone is not only unrealistic (given that the person overdosing is likely unconscious), but would be harmful if administered during an opioid overdose; thus is medically contraindicated under those circumstances (McIntyre et al., 2024; World Health Organization, 2009).
Naloxone, on the other hand, is a fast-acting opioid antagonist, which means that it quickly displaces the opioid agonists (pulls the plug), swiftly reversing their effects (McIntyre et al., 2024). Additionally, it blocks the receptor, preventing opioid agonists from plugging back in for a time (think of an outlet cover; McIntyre et al., 2024). It also works quickly (1-2 minutes, depending on the delivery method), reversing the effects of the opioid so that breathing is restored in time to save lives (McIntyre et al., 2024). Fast-acting means the benefits are almost immediate; unfortunately, it also means that it has a short half-life, meaning a second dose may be needed to sustain its effectiveness long enough for the opioid to clear the system (especially with fentanyl). The good news is that it’s safe to do so (McIntyre et al., 2024). And while it is relatively new on the public health/community harm reduction front, it’s been approved by the U.S. Food and Drug Administration (FDA) for more than half a century (McIntyre et al., 2024).
Developed in 1961 and approved in 1971 by the FDA, it was used almost exclusively in hospitals and ambulances to reverse opioid overdoses in surgery or emergency settings (Bennett & Elliot, 2021; McIntyre et al., 2024). Public awareness remained low until the 1990s, when community harm-reduction groups began pushing for broader access (Bennett & Elliot, 2021). In 1995, nalmefene, another opioid antagonist, gained FDA approval, one that is only slightly slower acting (5-15 minutes versus 1-2 minutes for naloxone) but lasts for 8-11 hours compared to ~80 minutes for naloxone (Edinoff et al., 2021). Nalmefene, like naloxone, was only available by prescription and had to be administered by injection, creating barriers to access for both life-saving drugs (Bennett & Elliot, 2021; Edinoff et al., 2021).
In the 2010s, once fentanyl hit the scene, public health authorities shifted course and began endorsing broader naloxone access (Bennett & Elliot, 2021). In 2015, the CDC finally officially recommended community naloxone distribution. In 2018, the FDA approved intranasal naloxone spray and auto-injector pens, and all 50 states allowed pharmacies to dispense naloxone without a prescription (Bennett & Elliot, 2021). Later, in 2023, the FDA approved intranasal naloxone for over-the-counter sale; a landmark win for public health and harm reduction efforts (FDA, 2023a). That same year, they approved intranasal nalmefene as a prescription, and the following year, the first nalmefene hydrochloride auto-injector to reverse opioid overdoses, also available by prescription (FDA, 2023b; FDA, 2024). As of 2025, naloxone sprays are available over the counter in most major pharmacies and online retailers, but the fight isn’t over. While over-the-counter availability may help increase access, cost becomes a barrier for the most at-risk (Gammon et al., 2025).
What’s Happening in the DoW and the VA?
Department of War (DoW) and Veterans’ Administration (VA) Initiatives
Given that by 2011, opioid overdose fatality rates for veterans being treated at VA hospitals were almost twice that of the civilian population, efforts were already underway to counteract the deadly impact of the epidemic (Bohnert et al., 2011). Beginning with pilot groups in 2013, the VA had launched the first national health-care system-based Opioid Overdose Education and Naloxone Distribution (OEND) program in the country (Oliva et al., 2017). This program led to the VA Rapid Naloxone Initiative (Oliva et al., 2017). Launched in 2018, the initiative provided OENDs to at-risk veterans and equipped VA police and Automated External Defibrillator cabinets with naloxone for emergency use (Oliva et al., 2021). The Uniformed Services University, in collaboration with the Defense Health Agency Research & Engineering Implementation Science Branch, implemented a similar OEND program for use in the Military Health System (MHS; Brendel, 2025; DoD, 2023). This included a clinical-decision support tool in MHS pharmacies to help flag patients at risk of overdose and prompt naloxone co-prescribing, leading to a 79.5% compliance rate for co-prescribing naloxone (Brendel, 2025; DoD, 2023).
We’re not done yet!
Challenges and Next Steps for the DoW and VA
Several notable challenges remain within DoW and VA. There is inconsistency in the doses prescribed, who prescribes them (pharmacists, physicians, etc.), and in what settings. Uncertainty about “whose job” it is to offer naloxone, and stigma preventing providers from talking with patients about overdose risks, add to these barriers (Sasson et al., 2023). There are also gaps in naloxone distribution regarding demographics and healthcare utilization (Oliva, Bustamante, & Zhu, 2024). Some programs do not have strong mechanisms to ensure patients who receive naloxone are also connected to treatment, overdose education, or further prevention services (Alexander et al., 2024; Knudsen et al., 2025). Within military and veteran systems, there are additional concerns about limited access to naloxone outside clinical settings—particularly in austere environments or among service members stationed in remote areas (DoD, 2023).
To maximize the benefits of this lifesaving intervention, we need to increase access, education, and normalization. Saturation of naloxone availability is an essential component in efforts to decrease opioid-related overdose deaths (Sugarman, Hulsey, & Heller, 2023). Both civilian and military efforts must focus on increasing access for people living in austere areas with limited medical and/or financial resources, as well as for high-risk populations (DoD, 2023). In healthcare settings, educating both clinical and non-clinical staff to normalize conversations about overdose prevention can increase readiness for overdose response and reduce stigma related to opioid use and overdose risk (Knudsen et al., 2025). Finally, greater efforts to connect individuals who have required naloxone to follow-up treatment can transform a life-threatening event in the short term into an opportunity for long-term recovery and stability (Knudsen et al., 2025).
Expanding naloxone access saves lives—but access alone isn’t enough. Providers must normalize conversations about overdose risk and ensure patients are linked to ongoing care. For military and veteran communities, this means aligning lifesaving medication access with consistent education, follow-up, and stigma reduction (Alexander et al., 2024; Oliva et al., 2024).
Expanding naloxone access saves lives, but access alone isn’t enough. Providers and leaders across the military and VA must normalize conversations about overdose risk, link patients to treatment, and reduce stigma at every level of care. The opioid epidemic may have deep historical roots, but its future — one built on education, compassion, and connection — is still ours to shape. Who can? We can, with Narcan.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.
Adria Williams, Ph.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences. Dr. Williams is a suicide prevention subject matter expert and trainer.
Part III References
Alexander, M., Houck, K. K., Hooker, J., Stratton, M., & Huh, M. (2024). Assessment of a naloxone distribution plan in a veteran population who experienced an opioid-related overdose event. Journal of the American Pharmacists Association, 64(3), 101999. https://doi.org/10.1016/j.japh.2023.12.018
Bennett, A. S., & Elliott, L. (2021). Naloxone's role in the national opioid crisis-past struggles, current efforts, and future opportunities. Translational research: the journal of laboratory and clinical medicine, 234, 43–57. https://doi.org/10.1016/j.trsl.2021.03.001
Bohnert, A. S., Ilgen, M. A., Galea, S., McCarthy, J. F., & Blow, F. C. (2011). Accidental poisoning mortality among patients in the Department of Veterans Affairs Health System. Medical care, 49(4), 393–396. https://doi.org/10.1097/MLR.0b013e318202aa27
Brendel, H. (2025, February 21). A lifesaving chance: The USU and DHA OEND Program increases naloxone distribution. Uniformed Services University News. https://news.usuhs.edu/2025/02/a-lifesaving-chance-usu-and-dha-oend.html
Edinoff, A. N., Nix, C. A., Reed, T. D., Bozner, E. M., Alvarez, M. R., Fuller, M. C., Anwar, F., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Pharmacologic and Clinical Considerations of Nalmefene, a Long Duration Opioid Antagonist, in Opioid Overdose. Psychiatry International, 2(4), 365-378. https://doi.org/10.3390/psychiatryint2040028
Gammon, D. G., Gaber, J., Saunders, M., & Zarkin, G. A. (2025). Estimates of first-year OTC naloxone sales in four U.S. states with high rates of opioid overdose deaths: KY, MA, NY, OH. Journal of substance use and addiction treatment, 178, 209762. https://doi.org/10.1016/j.josat.2025.209762
Johnson, R. E., Chutuape, M. A., Strain, E. C., Walsh, S. L., Stitzer, M. L., & Bigelow, G. E. (2000). A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. The New England journal of medicine, 343(18), 1290–1297. https://doi.org/10.1056/NEJM200011023431802
Kirchmayer, U., Davoli, M., Verster, A.D., Amato, L., Ferri, A., and Perucci, C.A. (2002). A systematic review on the efficacy of naltrexone maintenance treatment in opioid dependence. Addiction, 97: 1241-1249. https://doi-org.usu01.idm.oclc.org/10.1046/j.1360-0443.2002.00217.x
Knudsen, H. K., Back-Haddix, S., Andrews-Higgins, S., Goetz, M., Davis, O. A., Oyler, D. R., Walsh, S. L., & Freeman, P. R. (2025). Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky. Addiction Science & Clinical Practice, 20(1), 27. https://doi.org/10.1186/s13722-025-00553-2
McIntyre RS, Harris ME, Todtenkopf MS, Akerman S, and Burgett J (2024). Opioid antagonists: clinical utility, pharmacology, safety, and tolerability. CNS Spectrums 29(6), 542–548. https://doi.org/10.1017/S1092852924002189
Oliva, E. M., Bustamante, R., & Zhu, D. T. (2024). Identifying gaps in Veterans Health Administration (VHA) distribution of lifesaving naloxone. HSR&D Forum. https://www.hsrd.research.va.gov/publications/forum/spring24/default.cfm?ForumMenu=spring24-4
Oliva, E. M., Christopher, M. L., Wells, D., Bounthavong, M., Harvey, M., Himstreet, J., Emmendorfer, T., Valentino, M., Franchi, M., Goodman, F., & Trafton, J. A. (2017). Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration’s national program. Journal of the American Pharmacists Association, 57(2), S168-S179.e4. https://doi.org/10.1016/j.japh.2017.01.022
Oliva, E. M., Richardson, J., Harvey, M. A., & Bellino, P. (2021). Saving Lives: The Veterans Health Administration (VHA) Rapid Naloxone Initiative. The Joint Commission Journal on Quality and Patient Safety, 47(8), 469-480. https://doi.org/10.1016/j.jcjq.2021.06.004
Payte J. T. (1991). A brief history of methadone in the treatment of opioid dependence: a personal perspective. Journal of psychoactive drugs, 23(2), 103–107. https://doi.org/10.1080/02791072.1991.10472226
Sasson, C., Dieujuste, N., Klocko, R., Basrai, Z., Celedon, M., Hsiao, J., Himstreet, J., Hoffman, J., Pfaff, C., Malmstrom, R., Smith, J., Holstein, A., & Johnson-Koenke, R. (2023). Barriers and facilitators to implementing medications for opioid use disorder and naloxone distribution in Veterans Affairs emergency departments. Academic Emergency Medicine, 30(4), 289-298. https://doi.org/10.1111/acem.14683
Sullivan, M. A., Garawi, F., Bisaga, A., Comer, S. D., Carpenter, K., Raby, W. N., Anen, S. J., Brooks, A. C., Jiang, H., Akerele, E., & Nunes, E. V. (2007). Management of relapse in naltrexone maintenance for heroin dependence. Drug and Alcohol Dependence, 91(2-3), 289–292. https://doi.org/10.1016/j.drugalcdep.2007.06.013
Sugarman OK, Hulsey EG, Heller D. Achieving the Potential of Naloxone Saturation by Measuring Distribution. JAMA Health Forum. 2023;4(10):e233338. https//doi.org/10.1001/jamahealthforum.2023.3338
U.S. Department of Defense, Defense Health Agency. (2023). Opioid overdose education and naloxone distribution (OEND) program. https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Pharmacy-Operations/OEND-Program
U.S. Food and Drug Administration (2023a, March 29). FDA approves first over-the-counter naloxone nasal spray. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray
U.S. Food and Drug Administration (2023b, May 23). FDA approves prescription nasal spray to reverse opioid overdose. https://www.fda.gov/news-events/press-announcements/fda-approves-prescription-nasal-spray-reverse-opioid-overdose
U.S. Food and Drug Administration. (2024, August 7). FDA approves first nalmefene hydrochloride auto-injector to reverse opioid overdose. https://www.fda.gov/news-events/press-announcements/fda-approves-first-nalmefene-hydrochloride-auto-injector-reverse-opioid-overdose
Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA psychiatry, 76(2), 208–216. https://doi.org/10.1001/jamapsychiatry.2018.3126
World Health Organization. (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence (Annex 12, Prescribing guidelines). World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK143167/
Not All Superheroes Wear Capes, Some Wear Lab Coats
Short and Long-Term Medicinal Treatment of Physical and Psychological Dependence
Parts I and II explored how opioids act on the brain and how American history — particularly its wars — helped fuel cycles of addiction. Now, we turn to the present. This final installment of “Who Can? We Can, Narcan!” focuses on the lifesaving tools that can interrupt that cycle, from medication-assisted treatment to emergency overdose reversal. In the military and veteran communities, where resilience is both a strength and a barrier to care, these interventions are transforming how we talk about and respond to overdose risk.
During the Vietnam-Era epidemic, researchers were searching for ways to counter opioids’ destructive effects (Payte, 1991). This research resulted in two distinct trajectories, each with different medications and goals. One path focused on helping people overcome opioid dependence, leading to the development of agonist substitution treatment—a long-term method for addressing addiction by substituting a more potent full agonist opioid with a less potent opioid (i.e., levomethadyl acetate, buprenorphine, and methadone; Johnson et al., 2000). It also resulted in the development of a long-acting opioid antagonist that blocks opioid receptors, preventing opioid agonists from plugging back in and reducing relapse risk (Naltrexone; Kirchmayer et al., 2002). Because of how it works, Naltrexone is only given to patients who do not have opioids in their system–typically individuals who are in early recovery or who have completed the detoxification process (Sullivan et al., 2007). While each of these medications has risks and benefits, they share one thing in common: they are all important tools in the fight for sustained recovery (Volkow et al., 2019).
Naloxone to The Rescue!
Emergency Intervention
So we have powerful, if underutilized, weapons to help in the long-term treatment of opioid use disorder. But how do we decrease opioid overdose deaths in people who may not yet be in recovery or who unwittingly ingest a high-potency opioid? In the event of an overdose, the use of methadone, buprenorphine, or naltrexone is not only unrealistic (given that the person overdosing is likely unconscious), but would be harmful if administered during an opioid overdose; thus is medically contraindicated under those circumstances (McIntyre et al., 2024; World Health Organization, 2009).
Naloxone, on the other hand, is a fast-acting opioid antagonist, which means that it quickly displaces the opioid agonists (pulls the plug), swiftly reversing their effects (McIntyre et al., 2024). Additionally, it blocks the receptor, preventing opioid agonists from plugging back in for a time (think of an outlet cover; McIntyre et al., 2024). It also works quickly (1-2 minutes, depending on the delivery method), reversing the effects of the opioid so that breathing is restored in time to save lives (McIntyre et al., 2024). Fast-acting means the benefits are almost immediate; unfortunately, it also means that it has a short half-life, meaning a second dose may be needed to sustain its effectiveness long enough for the opioid to clear the system (especially with fentanyl). The good news is that it’s safe to do so (McIntyre et al., 2024). And while it is relatively new on the public health/community harm reduction front, it’s been approved by the U.S. Food and Drug Administration (FDA) for more than half a century (McIntyre et al., 2024).
Developed in 1961 and approved in 1971 by the FDA, it was used almost exclusively in hospitals and ambulances to reverse opioid overdoses in surgery or emergency settings (Bennett & Elliot, 2021; McIntyre et al., 2024). Public awareness remained low until the 1990s, when community harm-reduction groups began pushing for broader access (Bennett & Elliot, 2021). In 1995, nalmefene, another opioid antagonist, gained FDA approval, one that is only slightly slower acting (5-15 minutes versus 1-2 minutes for naloxone) but lasts for 8-11 hours compared to ~80 minutes for naloxone (Edinoff et al., 2021). Nalmefene, like naloxone, was only available by prescription and had to be administered by injection, creating barriers to access for both life-saving drugs (Bennett & Elliot, 2021; Edinoff et al., 2021).
In the 2010s, once fentanyl hit the scene, public health authorities shifted course and began endorsing broader naloxone access (Bennett & Elliot, 2021). In 2015, the CDC finally officially recommended community naloxone distribution. In 2018, the FDA approved intranasal naloxone spray and auto-injector pens, and all 50 states allowed pharmacies to dispense naloxone without a prescription (Bennett & Elliot, 2021). Later, in 2023, the FDA approved intranasal naloxone for over-the-counter sale; a landmark win for public health and harm reduction efforts (FDA, 2023a). That same year, they approved intranasal nalmefene as a prescription, and the following year, the first nalmefene hydrochloride auto-injector to reverse opioid overdoses, also available by prescription (FDA, 2023b; FDA, 2024). As of 2025, naloxone sprays are available over the counter in most major pharmacies and online retailers, but the fight isn’t over. While over-the-counter availability may help increase access, cost becomes a barrier for the most at-risk (Gammon et al., 2025).
What’s Happening in the DoW and the VA?
Department of War (DoW) and Veterans’ Administration (VA) Initiatives
Given that by 2011, opioid overdose fatality rates for veterans being treated at VA hospitals were almost twice that of the civilian population, efforts were already underway to counteract the deadly impact of the epidemic (Bohnert et al., 2011). Beginning with pilot groups in 2013, the VA had launched the first national health-care system-based Opioid Overdose Education and Naloxone Distribution (OEND) program in the country (Oliva et al., 2017). This program led to the VA Rapid Naloxone Initiative (Oliva et al., 2017). Launched in 2018, the initiative provided OENDs to at-risk veterans and equipped VA police and Automated External Defibrillator cabinets with naloxone for emergency use (Oliva et al., 2021). The Uniformed Services University, in collaboration with the Defense Health Agency Research & Engineering Implementation Science Branch, implemented a similar OEND program for use in the Military Health System (MHS; Brendel, 2025; DoD, 2023). This included a clinical-decision support tool in MHS pharmacies to help flag patients at risk of overdose and prompt naloxone co-prescribing, leading to a 79.5% compliance rate for co-prescribing naloxone (Brendel, 2025; DoD, 2023).
We’re not done yet!
Challenges and Next Steps for the DoW and VA
Several notable challenges remain within DoW and VA. There is inconsistency in the doses prescribed, who prescribes them (pharmacists, physicians, etc.), and in what settings. Uncertainty about “whose job” it is to offer naloxone, and stigma preventing providers from talking with patients about overdose risks, add to these barriers (Sasson et al., 2023). There are also gaps in naloxone distribution regarding demographics and healthcare utilization (Oliva, Bustamante, & Zhu, 2024). Some programs do not have strong mechanisms to ensure patients who receive naloxone are also connected to treatment, overdose education, or further prevention services (Alexander et al., 2024; Knudsen et al., 2025). Within military and veteran systems, there are additional concerns about limited access to naloxone outside clinical settings—particularly in austere environments or among service members stationed in remote areas (DoD, 2023).
To maximize the benefits of this lifesaving intervention, we need to increase access, education, and normalization. Saturation of naloxone availability is an essential component in efforts to decrease opioid-related overdose deaths (Sugarman, Hulsey, & Heller, 2023). Both civilian and military efforts must focus on increasing access for people living in austere areas with limited medical and/or financial resources, as well as for high-risk populations (DoD, 2023). In healthcare settings, educating both clinical and non-clinical staff to normalize conversations about overdose prevention can increase readiness for overdose response and reduce stigma related to opioid use and overdose risk (Knudsen et al., 2025). Finally, greater efforts to connect individuals who have required naloxone to follow-up treatment can transform a life-threatening event in the short term into an opportunity for long-term recovery and stability (Knudsen et al., 2025).
Expanding naloxone access saves lives—but access alone isn’t enough. Providers must normalize conversations about overdose risk and ensure patients are linked to ongoing care. For military and veteran communities, this means aligning lifesaving medication access with consistent education, follow-up, and stigma reduction (Alexander et al., 2024; Oliva et al., 2024).
Expanding naloxone access saves lives, but access alone isn’t enough. Providers and leaders across the military and VA must normalize conversations about overdose risk, link patients to treatment, and reduce stigma at every level of care. The opioid epidemic may have deep historical roots, but its future — one built on education, compassion, and connection — is still ours to shape. Who can? We can, with Narcan.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.
Adria Williams, Ph.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences. Dr. Williams is a suicide prevention subject matter expert and trainer.
Part III References
Alexander, M., Houck, K. K., Hooker, J., Stratton, M., & Huh, M. (2024). Assessment of a naloxone distribution plan in a veteran population who experienced an opioid-related overdose event. Journal of the American Pharmacists Association, 64(3), 101999. https://doi.org/10.1016/j.japh.2023.12.018
Bennett, A. S., & Elliott, L. (2021). Naloxone's role in the national opioid crisis-past struggles, current efforts, and future opportunities. Translational research: the journal of laboratory and clinical medicine, 234, 43–57. https://doi.org/10.1016/j.trsl.2021.03.001
Bohnert, A. S., Ilgen, M. A., Galea, S., McCarthy, J. F., & Blow, F. C. (2011). Accidental poisoning mortality among patients in the Department of Veterans Affairs Health System. Medical care, 49(4), 393–396. https://doi.org/10.1097/MLR.0b013e318202aa27
Brendel, H. (2025, February 21). A lifesaving chance: The USU and DHA OEND Program increases naloxone distribution. Uniformed Services University News. https://news.usuhs.edu/2025/02/a-lifesaving-chance-usu-and-dha-oend.html
Edinoff, A. N., Nix, C. A., Reed, T. D., Bozner, E. M., Alvarez, M. R., Fuller, M. C., Anwar, F., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Pharmacologic and Clinical Considerations of Nalmefene, a Long Duration Opioid Antagonist, in Opioid Overdose. Psychiatry International, 2(4), 365-378. https://doi.org/10.3390/psychiatryint2040028
Gammon, D. G., Gaber, J., Saunders, M., & Zarkin, G. A. (2025). Estimates of first-year OTC naloxone sales in four U.S. states with high rates of opioid overdose deaths: KY, MA, NY, OH. Journal of substance use and addiction treatment, 178, 209762. https://doi.org/10.1016/j.josat.2025.209762
Johnson, R. E., Chutuape, M. A., Strain, E. C., Walsh, S. L., Stitzer, M. L., & Bigelow, G. E. (2000). A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. The New England journal of medicine, 343(18), 1290–1297. https://doi.org/10.1056/NEJM200011023431802
Kirchmayer, U., Davoli, M., Verster, A.D., Amato, L., Ferri, A., and Perucci, C.A. (2002). A systematic review on the efficacy of naltrexone maintenance treatment in opioid dependence. Addiction, 97: 1241-1249. https://doi-org.usu01.idm.oclc.org/10.1046/j.1360-0443.2002.00217.x
Knudsen, H. K., Back-Haddix, S., Andrews-Higgins, S., Goetz, M., Davis, O. A., Oyler, D. R., Walsh, S. L., & Freeman, P. R. (2025). Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky. Addiction Science & Clinical Practice, 20(1), 27. https://doi.org/10.1186/s13722-025-00553-2
McIntyre RS, Harris ME, Todtenkopf MS, Akerman S, and Burgett J (2024). Opioid antagonists: clinical utility, pharmacology, safety, and tolerability. CNS Spectrums 29(6), 542–548. https://doi.org/10.1017/S1092852924002189
Oliva, E. M., Bustamante, R., & Zhu, D. T. (2024). Identifying gaps in Veterans Health Administration (VHA) distribution of lifesaving naloxone. HSR&D Forum. https://www.hsrd.research.va.gov/publications/forum/spring24/default.cfm?ForumMenu=spring24-4
Oliva, E. M., Christopher, M. L., Wells, D., Bounthavong, M., Harvey, M., Himstreet, J., Emmendorfer, T., Valentino, M., Franchi, M., Goodman, F., & Trafton, J. A. (2017). Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration’s national program. Journal of the American Pharmacists Association, 57(2), S168-S179.e4. https://doi.org/10.1016/j.japh.2017.01.022
Oliva, E. M., Richardson, J., Harvey, M. A., & Bellino, P. (2021). Saving Lives: The Veterans Health Administration (VHA) Rapid Naloxone Initiative. The Joint Commission Journal on Quality and Patient Safety, 47(8), 469-480. https://doi.org/10.1016/j.jcjq.2021.06.004
Payte J. T. (1991). A brief history of methadone in the treatment of opioid dependence: a personal perspective. Journal of psychoactive drugs, 23(2), 103–107. https://doi.org/10.1080/02791072.1991.10472226
Sasson, C., Dieujuste, N., Klocko, R., Basrai, Z., Celedon, M., Hsiao, J., Himstreet, J., Hoffman, J., Pfaff, C., Malmstrom, R., Smith, J., Holstein, A., & Johnson-Koenke, R. (2023). Barriers and facilitators to implementing medications for opioid use disorder and naloxone distribution in Veterans Affairs emergency departments. Academic Emergency Medicine, 30(4), 289-298. https://doi.org/10.1111/acem.14683
Sullivan, M. A., Garawi, F., Bisaga, A., Comer, S. D., Carpenter, K., Raby, W. N., Anen, S. J., Brooks, A. C., Jiang, H., Akerele, E., & Nunes, E. V. (2007). Management of relapse in naltrexone maintenance for heroin dependence. Drug and Alcohol Dependence, 91(2-3), 289–292. https://doi.org/10.1016/j.drugalcdep.2007.06.013
Sugarman OK, Hulsey EG, Heller D. Achieving the Potential of Naloxone Saturation by Measuring Distribution. JAMA Health Forum. 2023;4(10):e233338. https//doi.org/10.1001/jamahealthforum.2023.3338
U.S. Department of Defense, Defense Health Agency. (2023). Opioid overdose education and naloxone distribution (OEND) program. https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Pharmacy-Operations/OEND-Program
U.S. Food and Drug Administration (2023a, March 29). FDA approves first over-the-counter naloxone nasal spray. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray
U.S. Food and Drug Administration (2023b, May 23). FDA approves prescription nasal spray to reverse opioid overdose. https://www.fda.gov/news-events/press-announcements/fda-approves-prescription-nasal-spray-reverse-opioid-overdose
U.S. Food and Drug Administration. (2024, August 7). FDA approves first nalmefene hydrochloride auto-injector to reverse opioid overdose. https://www.fda.gov/news-events/press-announcements/fda-approves-first-nalmefene-hydrochloride-auto-injector-reverse-opioid-overdose
Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA psychiatry, 76(2), 208–216. https://doi.org/10.1001/jamapsychiatry.2018.3126
World Health Organization. (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence (Annex 12, Prescribing guidelines). World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK143167/