Enhancing Naloxone Reach Through Innovative Training Strategies at an Academic Medical Center in Arkansas

Abstract:

The Arkansas Naloxone Education and Training (ANET) program, based at the University of Arkansas for Medical Sciences, was developed to address the urgent need for opioid-overdose prevention across the state. Funded by the Substance Abuse and Mental Health Administration (SAMHSA), ANET uses a train-the-trainer model to equip health care professionals with the knowledge and tools necessary to deliver naloxone education in their local settings. In its first year, the program launched a three-module curriculum, accredited for continuing education, of health care professionals and delivered using an academic detailing teaching strategy, prioritized recruitment from counties through a needs assessment including the highest rates of opioids dispensed and of overdose deaths, and implemented a comprehensive evaluation plan that is grounded in an evidence-based framework that facilitates continuous evaluation and improvement (ie, RE-AIM framework—Reach, Effectiveness, Adoption, Implementation, and Maintenance). Knowledge and attitudes were assessed before and after health care professionals completed the training program. All trainers received technical support and outreach materials. The program also fostered strategic statewide partnerships to support recruitment, implementation, and community engagement. ANET is embedded within an academic medical center and aligned with continuing professional development infrastructure, offering a replicable model for community-centered overdose prevention. Lessons learned during the program's implementation underscore its potential to inform future design, delivery, and sustainability of similar interventions.

PROBLEM

The opioid crisis continues to claim over 100 lives each day in the United States, with more than 85,000 opioid-related overdose deaths reported nationwide in the 12 months ending January 2022.¹ In 2023, 92.6% of individuals ages 12 and older who misused opioids reported using prescription pain relievers that were not prescribed to them.^2–4 The impact has been both severe and persistent in Arkansas, where, in 2021, opioid-related overdose deaths accounted for 61% of all deaths due to drug overdose statewide.⁵ From 2011 to 2021, AR's age-adjusted opioid-overdose death rate more than doubled—from 6.2 to 13.7 per 100,000 people—which closely mirrored the national trend.⁵ In 2022, Arkansas recorded 487 opioid-overdose deaths. From January to July 2023, emergency departments treated more than 2260 individuals for suspected drug overdoses, most of which were opioid-related.⁶

Prompt and proper administration of naloxone, a fast-acting opioid antagonist, can reverse overdose symptoms and restore breathing, significantly reducing the risk of death from opioid overdose.^7,8 Recognizing its lifesaving potential, Arkansas enacted Act 284 of 2017, authorizing pharmacists to dispense naloxone without a prescription and supporting statewide naloxone protocols.⁹ From January 2023 through July 2023, Arkansas emergency medical services deployed naloxone 2723 times.⁶ However, significant gaps in naloxone access and education–particularly in rural and medically underserved counties–limit the life-saving benefits of naloxone.¹⁰

Although some community-based naloxone initiatives exist in Arkansas, many are pre-recorded, noninteractive formats (eg, online modules or videos) and are not integrated into the continuing professional development (CPD) systems that influence widespread clinical practice. For example, the Criminal Justice Institute provides a 1-hour online course about naloxone administration, but it is tailored for first responders.^9,11 The Naloxone Community Hero Project, led by the Arkansas Opioid Recovery Partnership,¹² limits eligibility to entities such as first responders, schools, colleges, community organizations, or businesses. Notably, however, funding from this agency does not extend to academic medical centers, such as University of Arkansas for Medical Sciences. Access to training and naloxone kits requires an approved application, with instruction delivered through a mobile app and a one-time safety briefing.¹² Although these programs expand naloxone access, they are not accredited for continuing education of health care professionals (HCPs), lack alignment with CPD frameworks, and they do not include a train-the-trainer (ToT) model, ongoing instructional support, or practical guidance for implementing community-based naloxone education. As a result, HCPs who routinely care for patients at high risk for opioid-overdose remain an underutilized resource in opioid-related harm reduction and prevention efforts. Despite their potential to educate, distribute naloxone, and connect individuals to treatment or support services, many HCPs report insufficient training and limited integration of standardized, CE-accredited naloxone education into their practice settings.¹³

SOLUTIONS

With funding from SAMHSA, University of Arkansas for Medical Sciences launched the Arkansas Naloxone Education and Training (ANET) program in Fall 2023 to address persistent gaps in naloxone access and education about the use of naloxone among HCPs. ANET uses a ToT model enhanced with an individualized teaching strategy, termed academic detailing (AD) to equip HCPs to deliver standardized, community- or clinic-based naloxone education. Trainers serve as educators and trusted community resources.^14–16 This approach reflects the growing call to expand CPD beyond traditional one-dimensional delivery toward dynamic, learner-responsive systems.¹⁷ CPD is evolving from episodic and self-directed activities to multidimensional frameworks that incorporate system-, team-, and patient-level outcomes.^17,18 Consistent with this shift, ANET integrates opioid-overdose education into professional practice, leverages institutional resources, and promotes sustained engagement between trainers and their communities through individualized instruction and ongoing program support.

Overview of Program Components and Educational Approach

The ANET curriculum consists of three 30-minute, CE-accredited modules delivered through one-on-one AD sessions. HCP trainees may complete the modules sequentially or within a single 90-minute session. This individualized structure promotes interactive learning, real-time discussion, and direct application of content to clinical and community contexts. During the session(s), trainees practice communication strategies such as motivational interviewing (MI), that mirror those used in community naloxone classes. Beyond the initial 90-minute training, ongoing quarterly check-ins, reporting, and guidance further strengthen trainers' skills, ensure consistency in community education, and sustain engagement over time. These elements form the foundation of the ANET curriculum, which was designed to adderss knowledge gaps among HCPs related to naloxone use and community-level opioid overdose prevention. The curriculum includes the following learning goals:

1. Provide foundational knowledge on naloxone pharmacology and safe administration for opioid-overdose reversals.

2. Introduce strategies to identify patients at high risk of overdose and to use antistigmatizing language in clinical settings.

3. Prepare trainers to deliver community education and to refer individuals to harm-reduction and treatment resources.

These goals were selected to reflect the dual priorities of clinical practice relevance and public health impact. Goal 1 ensures that HCPs recognize naloxone as a life-saving medication and feel confident in administering it in real-world settings. Goal 2 emphasizes stigma reduction not just as an ethical imperative but also as a clinical necessity for identifying and engaging with individuals at risk for opioid misuse. The curriculum incorporates person-first (nonstigmatizing) language and MI strategies, both of which are critical for fostering trust and supporting behavior change among patients and community members.^19–24

Goal 3 extends the reach of the program beyond individual learners by preparing HCPs to serve as naloxone educators within their own communities. This is achieved through ANET's ToT combined with AD model, which integrates clinical education with a peer-led dissemination approach. Trainers are supported through quarterly check-ins, structured reporting, and access to ANET staff, creating a learning community that reinforces accountability and continuous improvement.

These goals and objectives align with national guidance from SAMHSA, which emphasizes the need for timely, evidence-based education for HCPs administering naloxone.¹⁰ The cross-disciplinary curriculum also complies with recommendations from the National Institute on Drug Abuse for using person-first language, helping to reduce stigma in the care of individuals with substance use disorders (SUD). Finally, it supports broader public health goals by focusing on unmet needs and connecting individuals at high risk of opioid overdose to harm-reduction and treatment resources.^25–27 This includes outreach to rural and urban residents, people who use drugs, adolescents, older adults, and individuals with SUD.²⁸

ANET enhances the impact of education by connecting trainers and participants to tangible local and national harm-reduction resources.^10,29–31 These include the Never Use Alone hotline,³² free naloxone kits, and fentanyl test strips distributed by local harm-reduction organizations including the Central Arkansas Harm Reduction Coalition³³ and Northwest Arkansas Harm Reduction Coalition.³⁴ Integrating these services into CPD delivery improves both sustainability and real-world applicability by equipping HCPs and communities with tools that extend beyond the classroom. This resource-aligned approach offers a replicable, evidence-informed model for advancing overdose prevention through CPD.

Instructional Delivery and Trainer Support

Training is delivered one-on-one through Microsoft Teams by the ANET Lead Trainer (Physical Therapist) or, when necessary, by the Program Director (Pharmacist). These sessions incorporate AD techniques—an evidence-based approach to interactive learning that improves clinical practice through personalized, bidirectional education.^13,35,36 Importantly, ANET incorporates financial incentives to sustain trainer engagement and recognize the time commitment required for community education. During the first year of participation, trainers receive up to $150; in subsequent years, they are eligible for up to $120 ($30 for completing the curriculum and $30 per quarter for submitting reports and participating in the check-in calls). This incentive-aligned strategy supports trainer retention and affirms the value of their contributions. To support community class delivery, ANET provides a standardized 40-minute, plain-language educational module (reduced from 60 minutes in response to trainer feedback), along with outreach templates, local services, and resource guides. This approach reinforces CPD by promoting real-world application, sustained engagement, and long-term integration into clinical practice.^18,37,38

Evaluation Strategy and Continuous Improvement

To ensure effectiveness, reach, and sustainability, ANET was developed with a comprehensive implementation evaluation framework on the RE-AIM model—Reach, Effectiveness, Adoption, Implementation, and Maintenance.^39–41 It also ensures alignment with CPD best practices aimed at improving opioid-overdose education, expanding naloxone access, and reducing drug overdose-related harms in Arkansas communities. This framework supports continuous improvement by using real-time data to inform program delivery and responsiveness to both trainers and community participants. For example, ANET tracks naloxone classes and participant reach per county (Reach) and monitors the number of naloxone kits distributed and referrals to Opioid Use Disorder treatment (Effectiveness). All evaluation data are securely recorded in a REDCap database, enabling centralized tracking and timely analysis.^42,43

At the trainer level, ANET collects data from multiple sources. Eligible trainers include HCPs or graduate-level HCP students who complete a Registration and Commitment Form confirming their intent to participate and deliver naloxone education in their communities. To assess knowledge gains and attitude shifts, trainers complete pre- and post-training surveys that use the Opioid Overdose Knowledge and Attitudes Scale (OOKS), a validated instrument for measuring factual knowledge and confidence in overdose response.⁴⁴ Trainers also submit module-specific evaluation forms that provide feedback on instructional quality, delivery methods, content clarity, and relevance to clinical practice. Quarterly progress reports submitted by each trainer document the number of community classes delivered, participants reached, and naloxone kits distributed, and capture barriers to implementation and opportunities to improve program quality. With quarterly check-in calls, the ANET team and trainers share updates, troubleshoot challenges, and provide or receive support. These calls have been instrumental in refining program delivery during the first year and have fostered a sense of community among trainers. These calls have also facilitated “reverse recruitment,” in which external naloxone training requests are routed through the ANET team and matched with available trainers based on location and availability.

The evaluation process also includes community participants who receive education from trainers. Participants complete a registration form and are invited to participate in pre- and post-class OOKS surveys, along with a 30-day follow-up survey. These assessments measure a participant's knowledge retention and confidence in administering naloxone, as well as whether they used their naloxone kit, sought treatment, or engaged with various SUD-related resources and services after the session.

The ANET program regularly reviews evaluation data from trainer's quarterly reports to guide ongoing improvements. For example, trainer qualitative feedback led to the community education module being shortened from 60 to 40 minutes to improve feasibility and relevance without compromising core content. Additional refinements included incorporating a QR code to streamline community participant registration and preknowledge assessment completion, as well as developing a recruitment flyer to support community class outreach by trained trainers. Ongoing data monitoring enables the team to assess whether outreach efforts equitably reach the five priority county groups identified in the program's initial needs assessment. All Arkansas counties were sorted into priority groups based on published county-specific opioid-overdose rates for 2021, with group 1 containing the counties with the highest rates to group 5 having the lowest rates. Recruitment of trainers has been emphasized for higher-risk priority groups (1 and 2), but all interested and eligible participants have been accepted into the program. All priority groups had an average social vulnerability index between 0.41 and 0.64 (values range from 0 to 1, with higher values indicating greater vulnerability), and each represented rural and underserved populations.^45,46

In its first year, ANET recruited 34 trainers across 16 Arkansas counties (Table 1) and reached approximately 210 community members through local education sessions. Evaluation data also demonstrated early alignment with the program's needs assessment. Among the 12 highest-need priority counties, 15 trainers were recruited from three counties, and community education was delivered in six counties, reaching 124 individuals. Across all five priority groups, trainers were recruited from 16 of Arkansas' 75 counties (Figure 1), and naloxone education sessions reached participants in 27 counties. These early indicators of program reach in the first year of implementation demonstrate meaningful uptake in areas disproportionately affected by the opioid crisis, particularly those with the highest rates of opioid-related overdose deaths—and establish a foundation for ongoing equity-informed adjustments.

TABLE 1.

Demographic Characteristics of ANET Trainers and Community Participants in Year 1

Characteristic	Trainers (N = 34)	Participants (N = 210)
Age
18–24	5 (14.7%)	37 (17.6%)
25–34	13 (38.2%)	69 (32.9%)
35–49	8 (23.5%)	59 (28.1%)
50–64	7 (20.6%)	33 (15.7%)
≥65	1 (2.9%)	12 (5.7%)
Sex/gender
Male	6 (17.6%)	46 (21.9%)
Female	28 (82.4%)	163 (77.6%)
Nonbinary/Nonconforming	—	1 (0.5%)
Race
African American/Black	5 (14.7%)	45 (21.4%)
White	27 (79.4%)	152 (72.4%)
Asian	1 (2.9%)	9 (4.3%)
Native Hawaiian/Pacific Islander	1 (2.9%)	—
American Indian/Alaska Native	—	1 (0.5%)
Two or more races	—	3 (1.4%)
Ethnicity
Hispanic or Latino	4 (11.8%)	11 (5.2%)
Not Hispanic or Latino	30 (88.2%)	199 (94.8%)
LGBTQ+ Identity
Yes	4 (11.8%)	9 (4.3%)
No	28 (82.4%)	196 (93.3%)
Prefer not to respond	2 (5.9%)	5 (2.4%)
Rural/urban residence
Rural	6 (17.6%)	56 (26.7%)
Urban	28 (82.4%)	154 (73.3%)
Rural/urban employment
Rural	5 (14.7%)	—
Urban	29 (85.3%)	—
Practice setting
Hospital	5 (14.7%)
Clinic	8 (23.5%)
Pharmacy	9 (26.5%)
Other*	17 (50.0%)
Occupation
Nurses	4 (11.8%)
Pharmacists	8 (23.5%)
Other†	22 (64.7%)

^*Other practice settings include treatment centers and education centers.

^†Other occupations include child service specialist (1), community health workers (3), peer support specialists (5), pharmacy interns/students (6), counselors (3), mental health therapists (1), retired law enforcement (1), medical professions instructor (1), and sober-living home manager (1).

ANET, Arkansas Naloxone Education and Training.

FIGURE 1.

Trainers by priority group.

Figure 1 shows the distribution of ANET trainers recruited, sorted by the five priority population groups during the first year of implementation.

Figure 2 shows the distribution of community members trained by ANET trainers, sorted by the five priority population groups during the first year of implementation.

FIGURE 2.

Community participants by priority group.

Implications for Future CPD Design, Implementation, and Evaluation

The ANET program offers a replicable and scalable model that integrates opioid-overdose prevention into the structure of CPD for health care professionals. Its design addresses persistent gaps in training availability related to naloxone use and CE-accredited resources, particularly in areas with high opioid-overdose rates. ANET bridges the gap between public health priorities and clinical professional education by aligning its content with established standards for clinical practice and by using evidence-based teaching strategies (eg, AD). It accomplishes this through three core strategies operationalized within a five-task stepwise implementation framework (Table 2), adapted from Fernandez et al⁴⁷ (2019). First, embedding the training within CE/CPD frameworks–rather than relying solely on public health or community-based channels–ensures relevance to HCP roles and promotes knowledge-sharing and collaborative clinical decision-making. Second, individualized AD-style training and sustained engagement mechanisms promote accountability and strengthen peer-to-peer learning. Third, using validated tools such as OOKS for both trainers and community participants builds a growing evidence base for evaluating the effectiveness of naloxone education in health care settings. In addition to these structural features, the ANET program emphasizes antistigmatizing language and strong connections to local community resources, reinforcing its commitment to person-centered and sustainable education across diverse care settings.

TABLE 2.

Stepwise Implementation Mapping Framework for the ANET Program, Adapted From Fernandez et al (2019)

Task	Description/Application to ANET	Example
Task 1. Choose implementation strategies	Selection of a ToT model enhanced with AD addressing knowledge and practice gaps among HCPs ToT scales education through peer dissemination AD offers individualized, evidence-based instruction increasing sustained trainer engagement	1:1 CPD-accredited, AD sessions with HCP trainees Quarterly follow-up calls and reports serve as: ongoing coaching, audit-and-feedback mechanisms, reinforcing skills, engagement, and implementation fidelity
Task 2. Analyze overdose rates and naloxone administration data to identify priority areas	Review state- and county-level opioid overdose (fatal and nonfatal) Review naloxone administration data determining high-need regions for overdose education and naloxone access Use data to guide recruitment of interested HCP trainers from priority county groups (1–5)	Analysis of county-level data for targeted recruitment of HCP trainers from identified high-need county groups
Task 3. Develop evaluation tools and outcomes plan	Define performance objectives and measurable outcomes for HCP trainers and community participants Select validated instruments to assess knowledge, attitudes, and education and implementation effectiveness Build evaluation tools into data collection program	Use of OOKS/OOAS for pre/postassessment Monitor number of: HCP trainers trained, community classes delivered, community members trained, and naloxone kits distributed Use REDCap database for data collection
Task 4. Develop training materials and program support tools	Create standardized educational resources and management tools, supporting trainer preparation, community instruction, and program documentation Establish systems to streamline communication, scheduling, and data tracking	CPD curriculum modules Community class guide Preclass checklist ANET Leadership tools guide: Outreach tracking, MS bookings, REDCap, MS form for requesting naloxone kits before hosting community classes
Task 5. Evaluate implementation outcomes	Continuous assessment of implementation progress through quarterly calls and reports with trainers Incorporate qualitative feedback and performance data, guiding program improvement and sustainability	Evaluation guided by RE-AIM framework and CFIR reported to funder and trainers Includes: evaluation data (HCP trainers trained, community members educated, naloxone kits distributed) and summaries of quarterly calls with HCP trainers Performance reports to funder (quarterly, annually)

AD, Academic Detailing; ANET, Arkansas Naloxone Education and Training; CFIR framework, Consolidated Framework for Implementation Research; CPD, Continuing Professional Development; HCP, Health care Professionals; OOKS/OOAS, Opioid Overdose Knowledge Scale and Opioid Overdose Attitudes Scale; RE-AIM framework, Reach, Effectiveness, Adoption, Implementation, and Maintenance; ToT, Train-the-trainer.

ANET's first year highlights the value of adaptive feedback loops in professional development initiatives and demonstrates the program's real-world impact in community-level efforts to prevent overdoses due to opioid abuse. Responsive program changes–such as shortening the naloxone community education module based on trainer feedback–illustrate how CPD initiatives can evolve while preserving fidelity to core educational goals. This approach aligns with implementation science principles, which emphasize adapting strategies based on real-time data and stakeholder input.^41,48,49 In addition, the RE-AIM–guided evaluation allows the ANET team to monitor reach, adoption, effectiveness, enhancing recruitment, and implementation strategies that address disparities and expand equitable access to lifesaving overdose education.⁵⁰

Disclosure

The authors used ChatGPT, an AI language model developed by OpenAI, to assist with word-count refinement, and occasional synonym suggestions during manuscript preparation. All content was critically reviewed, revised as needed, and approved by the authors before submission.

CONCLUSION

The ANET program addresses a critical and ongoing issue–expanding access to naloxone and opioid-overdose response education in vulnerable communities. Through its use of CPD infrastructure at an academic medical center, ANET offers a replicable model that empowers and supports HCPs as community educators and overdose prevention advocates. Ultimately, ANET shows how academic institutions can lead scalable, evidence-based, community-focused naloxone education efforts through the lens of CPD programming. With opioid-related harms placing ongoing strain on health systems, CPD interventions such as ANET provide a timely way to equip providers with knowledge, confidence, and community engagement skills that are essential for effective opioid-overdose prevention.^14,35,51

By embedding a ToT model within a CE-accredited curriculum, ANET supports knowledge dissemination and boosts public health capacity across underserved areas. Incorporating antistigma education and MI techniques enhances provider confidence and improves communication with individuals at risk of overdose.^{20–22,52,53} Using real-time feedback and RE-AIM evaluation, the program has adapted, such as shortening the length of community naloxone classes without sacrificing fidelity or core content.^40,50

Initial outcomes from ANET's first year show strong reach and feasibility, with 32 trainers engaged across 16 Arkansas counties and more than 200 community members received education and naloxone kits (Table 1). These findings indicate the program is adaptable, scalable, and well-aligned with both public health priorities and CPD standards. These results highlight the power of academic-community partnerships in overcoming obstacles to effective overdose response. ANET strengthens overdose response efforts by positioning health care providers as trusted messengers and expanding local access to substance use disorder treatments and related resources.

Looking forward, ANET plans to enhance equity-focused outreach, build cross-sector partnerships, and deepen its impact across Arkansas. The program illustrates how CPD, paired with sustained trainer support, can serve as a powerful tool for public health, extending academic influences into communities hardest hit by the opioid crisis epidemic. CPD is increasingly recognized not just as a way to update clinical knowledge, but as a vehicle for driving behavioral and systemic change–especially when behavioral science principles are embedded in program design.⁵⁴ Forward–looking CPD models emphasize interactive learning and measurable improvements in practice–principles that ANET embraces through its structure and early success.⁵⁵

Lessons for Practice

• ■ Integrating opioid-overdose education into CPD systems foster interdisciplinary collaborations and empowers diverse health care professionals to deliver evidence-based training about naloxone use.

• ■ Prioritizing recruitment of trainers from high-need counties increases the reach, equity, and community relevance of CPD initiatives that address the opioid crisis.

• ■ Reducing stigma by using person-centered language and motivational interviewing improves engagement with priority groups and fosters community trust.