JMIR Publications

ABSTRACT

Background:

Wayne County, Michigan experiences the most overdose deaths in the state, reflecting a broader overdose crisis impacting communities throughout the United States. Community-based naloxone distribution is a proven harm reduction strategy, yet traditional distribution mechanisms fail to reach many people who are at risk of an overdose. To address this gap, the Well Wayne Stations Initiative aims to expand low-barrier access to naloxone and drug checking supplies through the implementation of public health vending machines (PHVM) and newsstand-style distribution devices across Wayne County.

Objective:

This protocol describes the implementation and evaluation of the Well Wayne Stations Initiative, a community-based naloxone distribution program delivered through low-barrier access points in Wayne County, Michigan. Guided by local overdose surveillance data, we apply two complimentary implementation science frameworks, RE-AIM to evaluate the initiative’s reach, effectiveness, adoption, implementation, and maintenance, and CFIR to identify the contextual factors shaping its uptake and sustainability.

Methods:

The initiative will deploy PHVMs and newsstands stocked with naloxone (Narcan) and drug checking supplies (i.e., fentanyl and xylazine test strips) across 43 municipalities in Wayne County. Implementation will be guided by health equity principles and phased across four years (2024–2027), with site selection informed by multiple quantitative and qualitative data sources, such as: local overdose fatality, surveillance, and EMS data from the Michigan Department of Health and Human Services (MDHHS); Wayne County Health, Human, and Veterans Services (WCHHVS), Biospatial, the Overdose Detection Mapping Application Program (ODMAP); and various community engagement activities, focus groups, semi-structured interviews, and community needs surveys.

Results:

Primary outcomes include reduced opioid-involved fatal and nonfatal overdose, increased naloxone access, and enhanced community engagement in and improved perception of harm reduction practices. Secondary outcomes include the influence of PHVM and newsstand placement on public perceptions, site-specific supply distribution, and barriers to implementation. Evaluation metrics will also consider health equity factors, police surveillance influences, and site-level perceptions of safety and accessibility.

Conclusions:

The Well Wayne Stations Initiative represents a scalable, community-driven model for expanding low-barrier naloxone access in a populous and diverse county. By integrating implementation science frameworks, this evaluation will generate evidence to optimize harm reduction strategies through PHVM and newsstand placement, offering insights for broader applications in similar localities.