Naloxone Distribution Mapped to Local Overdose Data
A Low-Barrier Model Built on Motel Outreach and Vending Machines
Alamance County uses opioid settlement funds to expand naloxone access in areas with high overdose rates. The county combines targeted community outreach, indoor and outdoor vending machines, and coordinated Save a Life Day events to make naloxone easier to access. Distribution is tracked by zip code, allowing the county to compare naloxone availability with local overdose trends.
The Challenge They Were Addressing
Alamance County had naloxone available, but its distribution approach was not reaching the communities most affected by overdose. In 2021, the county recorded 67 confirmed overdose deaths, while law enforcement reported hundreds of suspected overdoses. Although the health department had naloxone available, distribution primarily occurred through clinics. County leaders recognized the need to move naloxone beyond clinic walls and into the communities where overdoses were occurring.
Access was the primary challenge. People most likely to experience or witness an overdose were not necessarily seeking naloxone at health department clinics, and many community members did not know where to find it. Overdose data also showed that incidents were concentrated in specific zip codes and near several motels. The county needed a way to bring naloxone directly to the places and people most affected by overdose.
The Behavioral Health and Substance Use Division began testing a community-based distribution model in 2022, bringing naloxone and other essential supplies directly into areas with high overdose rates. By the time opioid settlement funding became available in 2024, the county had confirmed the need and identified where to expand. Settlement funds helped scale the approach countywide by supporting additional naloxone, CPR face shields, bilingual instructions, and a guide for available treatment services in the county.
What They Built
The county uses three strategies to expand naloxone access: direct outreach in areas with high overdose rates, two vending machines that provide naloxone with no interaction required, and Save a Life Day events across multiple partner sites. Distribution is tracked by zip code, allowing the county to monitor naloxone reach alongside overdose trends over time.
Direct outreach started with a simple approach: bring naloxone directly to the places where overdoses were occurring. County staff use a wagon to bring naloxone, water, socks, first aid kits, and resource information directly to motel corridors and neighborhoods with high overdose activity. Trusted partners often join the outreach, including Crossroads, which helps address sexual assault and human trafficking concerns that may overlap in these locations. Other community organizations and local media also participate, extending the program's reach.
Each overdose prevention packet includes naloxone, a CPR face shield, easy-to-read instructions in English and Spanish, and information about local treatment and recovery resources. Opioid settlement funds support the packet supplies, and the same standardized packet is distributed through community outreach and Save a Life Day events.
The county added its first naloxone vending machine in January 2024 on the Health and Human Services campus, through a partnership with North Carolina Healthy Blue. The location provides convenient access in the health and social service agency. Users simply enter their zip code or select "unhoused" or "other" to receive naloxone. In August 2026, the county added an outdoor, temperature-controlled machine within the motel corridor with high overdose activity. The second location builds on four years of outreach in the area and uses local data to place naloxone closer to the people most likely to need it.
Who You Need at the Table
What made a willing partner essential vs. optional?
Several partners are essential to sustaining the program. County commissioners authorize settlement spending, while NCDHHS and Vaya provide additional naloxone that helps extend settlement funds. Healthy Blue supported the vending machines, and the state technical assistance team provides ongoing guidance that helps the county manage and strengthen the program. Together, these partnerships provide the funding, supplies, infrastructure, and expertise needed to maintain the countywide approach.
Community partners strengthen the program and extend its reach. Crossroads brings trafficking support to motel outreach, while law enforcement, EMS, and hospital systems provide data that helps identify areas of greatest need. These partners are not required to operate the model, but their involvement makes outreach more informed, coordinated, and effective.
Budget Breakdown
What is the minimum viable budget to replicate this?
A rural county with $75,000 can run a version of this model on a single-year budget by prioritizing three things: supplemental naloxone to fill the gap between what the state distributes and what outreach demand requires, printing and packet supplies to standardize what goes into every hand, and one staff person's time to walk the zip codes the data points at. Vending machines are powerful but not day-one essential; a partnership with a Medicaid managed care organization or a state naloxone program can add a machine later. At a minimum, the model requires a reliable source of overdose data, a well-designed prevention packet, and staff committed to consistent outreach in the communities with the greatest need.
What Worked and Why
Specific decisions or design features that drove success
Zip-code tracking was the design choice that separated this program from a general distribution effort. From the beginning, every naloxone dose has been counted against a zip code, and every vending machine user enters a zip code before the door opens. Overdose data comes in by zip code from ODMAP, hospitals, and EMS. The two data sets can be overlaid, which lets the team see whether saturation is following the risk map. It also gives the commissioners a picture they can act on, instead of a total dose count with no geography attached.
Meeting the community before asking permission mattered. The division director spent 2022 in listening sessions with people in recovery, family members, law enforcement, treatment providers, and community organizations. Those conversations produced the gaps and needs picture that drove the March 2024 recommendations to the board. When the resolution came up for a vote in March 2024, commissioners had already seen a year of data and community input; the vote was unanimous.
Removing the disclosure barrier changed who the program reached. Handing naloxone only to people who walked into a clinic and named their use was screening in the wrong direction. The wagon-based outreach and the vending machines both remove that screening step entirely. A vending machine asks for a zip code and dispenses. A walk-up in a motel courtyard asks whether the recipient wants a packet and a resource sheet. Neither pathway requires anyone to identify themselves as a person who uses drugs.
Partnering on outreach visits makes the work safer and extends its impact. Crossroads joins county staff in motel areas where overdose, sexual assault, and human trafficking concerns may intersect. Working together allows both teams to address different needs during the same visit while providing additional support for staff in the field.
Connecting with other counties helped Alamance County learn what was working elsewhere and apply those lessons locally. Through regular meetings led by the Opioid Settlement Technical Assistance Team, county leaders discuss common challenges such as peer support staffing, funding applications, and local approval processes. This shared learning helps the county solve problems faster and build on approaches that other communities have already tested.
Early outcomes and data
Confirmed overdose deaths dropped from 67 in 2021 to 46 in 2024, with 26 confirmed for the first eight months of 2025.
Suspected overdoses reported by law enforcement dropped from 238 in 2022 to 112 in 2025, a decrease of more than 50%.
Second vending machine (outdoor, temperature-controlled) launched August 31, 2026, in the priority motel corridor.
Zip-code data infrastructure operational across outreach, vending machines, and community events.
Save a Life Day expanded to nine coordinated county sites in 2025; participation set for September 24, 2026.
Bilingual English and Spanish instructions distributed with every packet.
Program-level qualitative success stories collected from every settlement-funded strategy for board reporting.
Lessons Learned
Know the audience before the conversation. Chiefs, commissioners, clinicians, treatment providers, family members, and people with living and lived experience each hear the work differently. The division director spent a 12-hour ride-along shift with EMS before she asked EMS for anything. Do the equivalent for every partner category. Meet people in their world before asking them to enter yours.
Data is the currency of the county room. Every recommendation to the board carries confirmed deaths, suspected overdoses, and vending machine dispenses by zip code. That is what turned a difficult conversation into a unanimous vote and what continues to earn the program the trust to come back with the next round of recommendations.
Start small, and make what already exists work harder. The program began with a closet of naloxone the county already had, a wagon, and existing community relationships. Settlement funds scaled a model that had already been tested. Build the foundation first, then let the funding accelerate it.
Fund in two-year increments and let data drive reauthorization. The county funds strategies in two-year cycles with data checkpoints. That posture keeps the program responsive to a drug supply that has changed dramatically in five years and gives the commissioners a clear moment to reauthorize based on evidence.
Peer learning across counties is not optional. The North Carolina Opioid Settlement Technical Assistance Team is the reason a mid-sized county can operate at this level of sophistication. If a similar structure does not exist in the state, build informal peer connections with two or three other counties doing settlement work and meet monthly.