Written by Elizabeth Cairns, Mobilize Recovery Special Projects and Michael Masiowski, MD, reviewed by Code Recover Clinician Advisors, August 2026

Overdose prevention is a pragmatic, evidence-based approach that aims to reduce the negative consequences associated with substance use, rather than demanding immediate abstinence. Overdose prevention recognizes that some patients will continue to use substances and that minimizing associated risks, particularly overdose, infectious complications, and death, is an important health priority. This approach is non-judgmental and person-centered, respecting patient autonomy, while building therapeutic relationships that facilitate engagement in care and may ultimately lead to further treatment.

Overdose prevention resources may include providing overdose reversal kits, fentanyl test strips, and education on approaches to prevent other adverse events like endocarditis and Hep C/HIV infection. It is not in opposition to abstinence-based goals but rather complements them by keeping patients alive and engaged in care, even when they are not yet ready or willing to pursue abstinence. Distributing naloxone to people at risk of overdose has been shown to reduce overdose deaths and to be cost-effective by standard health economic measures. (source) Additionally, providing these resources in the ED builds trust with a population that often feels stigmatized by the medical system.

For the ED clinician, overdose prevention is a life-saving bridge. If a patient is not ready to start a medication for OUD today, providing them with a naloxone kit and additional resources ensures they stay alive long enough to potentially make a different choice tomorrow.

Obtaining naloxone for your department

The most common barrier to ED naloxone distribution is not policy or cost — it is that no one has set up the supply. Most departments have three options, and many use more than one.

State health department programs: Many state health departments operate overdose education and naloxone distribution programs that supply naloxone free of charge to qualifying organizations, including hospitals. Requirements vary by state, with some requiring an application, a designated responsible party, or a distributor license. Check with your state’s health department to see if they have an overdose prevention or naloxone program.

Regional and academic distribution programs: Some programs supply participating hospitals with free naloxone rescue kits specifically for ED distribution. Michigan OPEN's Emergency Department Naloxone Distribution Program is one model. (resource)

Pharmacy-assembled kits: Your hospital pharmacy can assemble kits and either send them to the ED or stock them in an automated medication management system for nursing retrieval. Many EDs operate under a physician standing order, so kits can be dispensed at the discretion of a nurse, social worker, or peer navigator without a separate prescription for each patient. (resource)

One significant operational note: giving a patient a prescription for naloxone is not the same as handing them a kit. In a study at one academic medical center, an e-prescribing program produced 348 naloxone prescriptions but only 133 that were actually filled; when the department switched to handing patients naloxone directly at discharge, 327 kits went home with patients. (source) It is worth the extra effort required to source the naloxone kits to know that your patient has that safeguard with them when they leave.