A Lifesaving Chance: The USU and DHA OEND Program Increases Naloxone Distribution
The USU and DHA Opioid Overdose Education and Naloxone Distribution (OEND) program combats opioid overdoses by increasing naloxone access and education, ultimately saving lives.
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| Naloxone is a temporary, but rapidly-acting antidote against opioid overdose. Administered via an IV or sprayed through the nostrils, naloxone restores respiration and breathing in someone suffering from opioid poisoning. (Photo credit Janet A. Aker) |
February 21, 2025 by Hadiyah Brendel
Opioid overdoses are a serious public health crisis, and the Uniformed Services University (USU), in collaboration with the Defense Health Agency (DHA) Research & Engineering Implementation Science Branch, is tackling this issue head-on with the Opioid Overdose Education and Naloxone Distribution (OEND) Program. This initiative focuses on increasing access to naloxone, a life-saving antidote, and educating both providers and patients about its importance.
The Need for Naloxone Access and Education
While many recognize the dangers of opioids and their link to fatal overdoses, awareness of naloxone—an emergency medication that can rapidly reverse an opioid overdose—remains limited. Addressing the opioid crisis requires not only understanding the risks of opioid use but also ensuring widespread knowledge and availability of naloxone. Despite its life-saving potential, naloxone remains historically underprescribed.
One contributing factor is that some prescribers assume their patients are unlikely to misuse opioids. Others may hesitate due to the stigma surrounding naloxone use. However, the reality is that anyone prescribed opioids faces a risk of accidental overdose. Factors such as medication interactions, alcohol consumption, or a weakened immune system can all increase this risk.
Since 2019, the OEND program has worked to de-stigmatize conversations about opioid use and expand access to naloxone, ensuring that more people are prepared to prevent overdose deaths.
Creating the OEND Program: A Collaborative Effort
The Defense and Veterans Center for Integrated Pain Management (DVCIPM) at USU, inspired by the Veterans Administration’s Opioid Education and Naloxone Distribution (OEND) program, partnered with the Defense Health Agency (DHA) to tailor the initiative for the Military Health System (MHS). Leading this effort are Dr. Kris Highland, associate professor of Anesthesiology at USU, and retired Army Col. Kevin Galloway, DVCIPM’s director for Strategic Communications and Policy. Galloway also highlights the pivotal contributions of retired Army Col. (Dr.) Chester Buckenmaier III, DVCIPM’s founding director, in shaping the MHS pain management infrastructure.
A key element of OEND is encouraging providers to “co-prescribe” naloxone alongside opioid painkillers for patients with elevated overdose risks, including those on long-term opioid therapy, high opioid doses, concurrent respiratory depressants (such as benzodiazepines), or with a history of behavioral health conditions. This sustained effort has led to an impressive 79.5% compliance rate for co-prescribing naloxone.
How Naloxone Saves Lives
Naloxone is a fast-acting medication that temporarily reverses opioid overdoses by restoring breathing. Administered via IV or nasal spray, it works by binding to opioid receptors, blocking the effects of opioids, and counteracting the respiratory depression that can be fatal. While naloxone can be used by anyone in an emergency, it is not a replacement for professional medical care. Its effects are temporary, and individuals who receive naloxone still require immediate medical attention to ensure their safety and prevent a recurrence of overdose symptoms.
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| The Opioid Overdose Education and Naloxone Distribution (OEND) Program, developed at the Uniformed Services University (USU) in collaboration with the Defense Health Agency (DHA) Research & Engineering Implementation Science Branch, builds education around naloxone as a lifesaving antidote against overdose from prescription opioid use. (Courtesy of health.mil/oend) |
OEND’s Three-Phase Approach
The OEND program is specifically tailored to the MHS to bridge the gap between policy and practice. Highland’s team discovered that despite existing DoD policies promoting naloxone distribution, prescribing rates remained stagnant. While these policies allowed both physicians and pharmacists to prescribe naloxone and outlined opioid safety and pain management guidelines, they lacked the necessary programming and tools to effectively disseminate this information, slowing meaningful change.
To address this, the program was structured into three phases. Phase One began with interviews of clinicians and pharmacists to assess training and resource needs. Collaborating with OEND champions at Madigan Army Medical Center, the team developed targeted tools and training to enhance access to patient prescription history, improve provider-patient discussions about naloxone, and reduce stigma surrounding its use. Training focused on locating opioid prescription history and overdose risk indicators in CarePoint, initiating informed conversations with patients, and addressing stigma among both healthcare providers and patients.
A post-training review of 47 participating clinicians and pharmacists revealed that most regularly worked with patients concerned about opioid risks, and roughly 40% had received direct naloxone information requests from patients or caregivers.
Following the training, prescribers reported increased confidence in normalizing conversations about naloxone and educating patients on its benefits. Open discussions about opioid safety are essential—covering medication storage, access, and disposal, as well as how conditions like sleep apnea and medications such as benzodiazepines can heighten the risk of opioid-induced respiratory depression.
"Patients sometimes forget they've taken their medication and accidentally double-dose," Highland explains. "Or they take their medication as prescribed, have a couple of drinks, and don't realize they've increased their risk of respiratory depression. Many things can happen accidentally. Empowering patients with knowledge for informed health decisions is a key component of OEND," Highland emphasizes.
Reaching a Wider Audience
In collaboration with the DHA, the OEND Program launched a dedicated Health.mil page to provide comprehensive resources for patients, caregivers, providers, and trainers. This centralized hub offers opioid fact sheets, infographics, videos, and train-the-trainer handbooks—all in one accessible location. Designed to support prescribers, pharmacists, and OEND champions, the site ensures that critical information is readily available to those who need it.
A complementary social media campaign further amplifies the program’s reach, reinforcing the importance of naloxone education and accessibility. As Galloway emphasizes, “What if you had a fire extinguisher but didn’t know what it does?”
An Ongoing Effort
The OEND program remains committed to continuous improvement, ensuring providers have the tools and knowledge to engage patients effectively. “The teaching is different now,” Galloway explains. “We’re no longer just telling medical students to ‘treat the pain, treat the pain.’”
While recent data suggests a decline in overdose deaths, Galloway attributes this to a combination of factors, including expanded naloxone access, harm reduction efforts, and greater awareness. He underscores that DVCIPM is not anti-opioid—these medications can be invaluable when prescribed and used responsibly. “The culture [around opioid prescribing] is still in the process of changing, and we’re better than we were, but not quite as good as we need to be,” he says.
Looking ahead, Highland highlights the program’s vision for a “triple risk-reduction kit”—a comprehensive emergency care package combining defibrillators, Stop the Bleed supplies, and naloxone. “We can’t predict where someone will have an overdose event, we can’t predict where there will be a mass casualty event such as a mass shooting, and we can’t predict when and where someone will have a cardiovascular incident that requires a defibrillator,” Highland notes. “So if you were to put those three together, and create awareness around that and create training information on how to use each part of the triple kit, then that would be the new emergency care kit that would be available to people.”
