State naloxone portals: a national comparative content analysis and case study of Indiana

Abstract Background The US continues to face an overdose crisis with nearly one million opioid-related deaths in the past two decades. Naloxone, an opioid antagonist, effectively reverses opioid overdoses and its distribution through state programs is linked to significant declines in overdose mortality. Although naloxone access laws and state-funded initiatives have expanded availability, the role of state-affiliated online portals for naloxone ordering remains unexamined. Methods We conducted a multi‑method study comprising a (1) heuristic evaluation of state-affiliated naloxone portals across all 50 states and DC (July 2025), coding features such as eligibility, training mandates, order limits, and additional supplies; and (2) descriptive analysis of 48 months (January 2021–December 2024) of administrative data from Indiana’s state‑affiliated naloxone portal. We captured portals’ features (e.g., eligibility, training requirements, order limits, naloxone formulation, and availability of additional materials) and examined Indiana’s portal order data by requestor types, product orders, and temporal patterns. Results Among 34 state‑affiliated portals identified, 41% allowed both individual and organizational orders; 24% required training; and 76% offered only intranasal naloxone. Additional supplies (e.g. fentanyl or xylazine testing strips) were available in 35%. Indiana’s portal processed 24,553 orders, distributing over 1,127,343 naloxone kits. Individuals represented the highest percentage of all orders (57%), but distributors requested the greatest proportion of kits (50%). Utilization fluctuated, yet increased steadily, from 2021 to 2024. Conclusions State-affiliated naloxone portals in the United States differ substantially in design and accessibility. Findings highlight opportunities to expand naloxone access by optimizing portal design and reducing access barriers.