Staying Alive Drug Overdose Prevention and Response Program

An overdose prevention program model in Baltimore that utilizes targeted naloxone distribution, naloxone training, and overdose education

Staying Alive Drug Overdose Prevention and Response Program, through the Baltimore City Health Department, has taught more than 3,000 injection drug users, drug treatment clients and providers, prison inmates, and corrections officers about how to prevent drug overdoses. More than 220 reversals (lives saved) have been documented.

The Staying Alive training program teaches individuals how to recognize an opioid overdose and respond by calling 911 and administering rescue breathing and the drug naloxone. The program also connects users to treatment and other services.

Staying Alive started in 2004 as a public health intervention begun by the former health commissioner to educate and train drug users on opioid overdoses and naloxone and, in 2015, began to train providers and correctional staff. Trainings first occurred at the syringe service program and now occur at various treatment centers throughout the city and the Baltimore Detention Center.

More than 220 reversals, thus lives saved, have been directly attributed to this program.

Continuum of Care
Harm Reduction
Type of Evidence
Response Approach
Overdose prevention
Syringe service program / Needle exchange
Peer-reviewed Article

Evidence of Program Effectiveness

As of September 30, 2018, the program reports that 34,644 individuals have been trained including 2,164 providers and correctional staff in just the past two years. More than 220 reversals, thus lives saved, have been directly attributed to this program. Since the program began, 26,130 naloxone kits have been distributed and 2,616 reversals have been reported.

"Consistent with previous evaluations of naloxone overdose prevention programmes, our data indicate that the Staying Alive programme was effective in increasing the use of naloxone during opiate overdoses, resulting in 22 reversals by 19 individuals. Furthermore, the programme was effective in training on overdose response skills not involving naloxone. On average, frequency of inappropriate responses (leaving the victim or applying pain) decreased. We observed a decrease in the rate of calling for an ambulance from 65% at baseline to 49% post-intervention. In the majority of these cases when the ambulance was not called it was due to the overdose victim regaining consciousness or the witness feeling confident that they could revive them without external medical assistance. This underscores the importance of including clear messages about overdose relapse potential when naloxone is used. Programmes should thoroughly review methods for assessing resuscitated victims for relapse (such as monitoring their level of consciousness) and programme participants should be encouraged to call for medical services if they observe or suspect relapse. Moreover, programmes should stress the importance of avoiding further use of opiates, alcohol or other drugs after naloxone resuscitation because of relapse potential.” (Tobin et al., 2009)