Anti-overdose naloxone kits at transit stops could help save lives, study suggests

Researcher Benjamin Leung carries a naloxone kit in his backpack in case of encountering an opioid overdose — but he admits that's about as practical as carrying a fire extinguisher in case of fire.

Instead, Leung is now advocating a new tactic of placing the overdose-reversing kits at transit locations near where drug poisonings are known to occur, after co-authoring a study suggesting the benefits of the strategy.

 "We just want to know, 'Where can I go get one so that I can use it right away,'" said Leung.

The study, published in the Canadian Medical Association Journal on March 17, found that naloxone kits placed at public transit locations had the "greatest coverage" and efficiency for potentially reversing drug overdoses.

It compared the locations of 14,089 opioid poisonings in Metro Vancouver from 2014 to 2020 with 647 locations supplying take-home naloxone.

Those locations "covered" about 35 per cent of poisonings, meaning they were within a three-minute walk.

By comparison, placing naloxone at just 10 particular transit stops resulted in coverage of more than 20 per cent, while 1,000 kit locations at transit stops would have resulted in coverage of more than 53 per cent.

While "blanket placement" of kits at take-home naloxone locations meant coverage of a "substantial portion" of poisonings, "optimized placement … at transit locations was most effective at improving public accessibility of naloxone," the study says.

Placing kits at pharmacies meanwhile resulted in coverage of about 22 per cent, while placement at fast-food restaurants was 16.5 per cent.

Leung, a research fellow at Duke University in North Carolina and a recent PhD graduate at the University of Toronto in health systems engineering, said the current program raised the question: "How often are we carrying the naloxone kits with us?"

Leung said he has a kit in his backpack, but doesn't always carry his backpack around — just as we don't always carry a fire extinguisher.

The study led by Leung identified more than 8,900 public transit stops across Metro Vancouver as candidate locations for the placement of public naloxone kits.

However, Leung said that while opioid poisoning could occur anywhere, it would not be cost-effective to place naloxone kits at every transit stop. 

Naloxone kits cost between $30 and $50 each, and distribution fees and putting them in a container for public access raised the cost to between $150 and $200 per kit, said Leung.

"We're not necessarily saying we should put one on every bus stop, but in high-risk areas," said Leung.

Leung said public transit stops are "easily recognizable."

"We already do this strategy with defibrillators … and we can use this same kind of strategy to inform us of where these naloxone kits should be placed," he said. 

He added that downtown Vancouver, Surrey, and New Westminster are overdose "hot spots" based on the research. 

Leung said downtown Vancouver, north of False Creek, is "well-served" by the current take-home naloxone programs, but coverage of other areas needs to be improved.

"We can strike a balance of between having them consistently available in places that are easy to remember but also in high-risk areas or areas experiencing high rates of opioid poisoning where we can best allocate our resources." 

The study said researchers hope the findings will inform policy-makers to maximize naloxone accessibility and prevent overdose deaths. 

More than 16,000 people have died of toxic drug overdoses in B.C. since the province declared a public health emergency in 2016.

The BC Coroners Service recently announced that 152 people died of toxic drug overdoses in January. That was down more than 30 per cent from January 2024, part of a broad decline in overdose fatalities across Canada and the United States. 

This report by The Canadian Press was first published Mar. 23, 2025.