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timeframes: Group 1 (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) and Group 2 (2018)(2019)(2020)(2021)(2022).Studies included reported individual-level survival outcomes following naloxone administration in community-based OEND programs.Data were analyzed by population group, naloxone route, dose, training duration, and geographic location. ResultsIn the first group of 41 studies conducted between 2003 and 2018, overall survival after naloxone administration in community settings was 97.3%.When stratified by population, survival rates were highest among people who use drugs (PWUD) (98.3%), followed by family or community members (95.0%), and law enforcement personnel (92.4%).The second group of studies (2018-2022) demonstrated similarly high effectiveness, even as illicit fentanyl became increasingly prevalent, confirming that naloxone distribution remained effective despite the more potent opioid landscape.At the community level, areas where overdose education and naloxone distribution (OEND) programs were implemented saw reductions in overdose mortality of up to 46%, underscoring not only the individual-level benefit but also the broader population impact of these interventions. ConclusionCommunity-based naloxone distribution programs are highly effective at reducing opioid overdose deaths, with sustained high survival rates even amid the rise of fentanyl.The findings support broader implementation and access to naloxone in community settings.Critique Strengths include a large number of studies, robust meta-analytic methods, and real-world applicability.Limitations include reliance on passive follow-up, potential publication bias, lack of control groups, and