Howard County Naloxone Leave Behind Program

An EMS-based program in Maryland that gives naloxone to individuals who have experienced a nonfatal opioid overdose and refuse to go to the hospital

The Howard County Naloxone Leave Behind Program (HCNLB) is a collaboration between the Department of Fire and Rescue Services (DFRS) and the Howard County Health Department (HCHD) that began in June 2018 with an aim to leave naloxone kits with every patient, or their immediate social network, who experiences a nonfatal overdose in the county. The DFRS is responsible for distributing kits to individuals at the scene of an overdose and the HCHD is responsible for providing naloxone kits for distribution and follow-up services with Peer Recovery Support Specialists (PRSS).

Many people who are treated by EMS after a nonfatal opioid overdose refuse medical transport. The HCNLB allows kits to be left with the patient, their family members, or cohabitants at the scene, regardless of whether the patient is transported to the hospital, increasing naloxone distribution to a high-risk population. 

When a kit is accepted at the scene of an overdose, EMS obtains the best possible phone number for future follow-up by a health department PRSS, although a kit will still be left if the patient refuses to provide a phone number. Health department PRSSs are notified after a kit is left at the scene of an opioid-related event, with instructions to reach out to the individuals within 24 to 48 hours to offer connections to treatment and recovery services.

A leave behind naloxone initiative has been replicated in other areas. Preliminary evidence indicates that giving naloxone to social networks, such as family and friends, has benefits for the individual who experienced the overdose. 

Increasing naloxone distribution to a high-risk population that do not present to the healthcare system

Continuum of Care
Harm Reduction
Type of Evidence
Response Approach
Overdose prevention
Post-overdose response
Peer-reviewed Article

Evidence of Program Effectiveness

"From June 2018 to June 2019, Howard County Department of Fire and Rescue Services responded to 239 overdose calls and distributed 120 naloxone kits to individuals on the scene of an overdose, a 50.21% distribution rate. The HCNLB program connected 143 patients (59.83%) to peer recovery specialists. Among the 143 patients linked to peer recovery support specialist services, 87 (60.84%) had accepted an NLB kit from EMS...those whose kit was left with a family member on the scene were 5.16 times more likely to be connected to peer support specialists...those whose kit was left with a friend or given directly to the patient were 3.69 times and 2.37 times more likely, respectively, to be connected to follow up services as compared to those who did not accept a kit." (Scharf et al., 2020)