Date: December 8, 2023 

Dear Housing Provider: 

The U.S. Department of Health and Human Services (HHS), the U.S. Department of Housing 

and Urban Development (HUD), and the White House Office of National Drug Control Policy 

(ONDCP) are partnering to fight the overdose epidemic. 

Drug overdose deaths in the United States, driven by illicit fentanyl and other opioids, remain at 

historically high levels – with more than 107,000 lives lost in the past year.1 And millions more 

struggle with opioid and other substance use disorders.2 This crisis reaches every corner of our 

country and requires that entire communities work together for effective solutions. 

HHS, HUD and ONDCP are committed to working together and with communities to improve 

access to life-saving measures, destigmatize addiction, and promote recovery. We call on the 

public health sector to engage housing providers, community development organizations, and 

other housing entities to maximize the impact of evidence-based practices that can save lives, 

including making naloxone and other opioid overdose reversal medications readily available 

where people live. Similarly, we support HUD grantees who seek to proactively engage with 

public health and other community organizations to combat the opioid crisis and keep their 

communities safe. 

A key strategy to reducing overdoses, as outlined in the President’s National Drug Control 

Strategy and HHS Overdose Prevention Strategy, is expanding the availability of naloxone and 

other opioid overdose reversal medications. Naloxone and other opioid overdose reversal 

medications are FDA-approved and can reverse the life-threatening effects of opioids, including 

prescription opioids (e.g., oxycodone and hydrocodone) and illicit opioids (i.e., heroin and illicit 

fentanyl). 

Naloxone and other opioid overdose reversal medications provide an extra layer of protection 

against preventable opioid-involved overdoses. Carrying these medications is no different than 

carrying an “EpiPen” (a commonly known brand name epinephrine auto-injector) out of concern 

for someone with life-threatening allergies. Making it easily accessible in communities is a key 

aim of our collaborative efforts. 

It is important for communities to know the facts about this category of life-saving medications. 

Naloxone and other opioid overdose reversal medications are safe and easy to administer, do not 

produce any euphoric or mind-altering effects, and have no potential for addiction. Providing 

training to those who work with individuals who are experiencing homelessness, others at risk of 

overdose, and the lay public who might respond to an overdose is a key strategy in ensuring 

naloxone and other opioid overdose reversal medications are effectively administered during 

overdose situations. 

1 https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

2 Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH). https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health
Fortunately, naloxone and other opioid overdose reversal medications are now more readily 

available. The FDA has recently approved nonprescription (over-the-counter or OTC) naloxone 

products. OTC Narcan is now on shelves in pharmacies, grocery stores, and other retail settings, 

with newly approved products slated for such availability in 2024. 

In addition, SAMHSA provides grant funding to states, territories, Tribes, and community 

providers to support the purchase and distribution of naloxone and other opioid overdose reversal 

medications and training for their use. For example, between September 2018 and March 2023, 

states and territories receiving State Opioid Response (SOR) grant funds have distributed over 8 

million opioid overdose reversal kits, resulting in over 500,000 overdose reversals. While this is 

likely a significant underestimate, as overdose reversal data are often challenging to fully 

capture, this means over a half a million opportunities for people experiencing an overdose to 

live another day. That’s why SAMHSA’s work to help states and territories expand access to 

naloxone and other opioid overdose reversal medications through partnerships with emergency 

medical services, community-based organizations, schools and universities, behavioral health 

departments, public libraries, faith-based organizations, veteran organizations, and other entities 

will ensure that people have the supplies they need to keep themselves and others safe. 

We call on public health departments and health care systems to engage with affordable housing 

providers and community development organizations to help expand the reach of these lifesaving measures. A model of this successful engagement to improve access to naloxone and 

other opioid overdose reversal medications in public housing occurred in St. Louis, MO. Partners 

from across the community, including a non-profit organization, a federally qualified health 

center, and the local health department collaborated with the (local) St. Louis Public Housing 

Authority to successfully distribute naloxone to residents and provide overdose recognition and 

response training to housing residents and property managers. 

Housing providers, including and especially those assisted by HUD programs, can play an 

important role in helping expand access to naloxone and other opioid overdose reversal 

medications and associated training in the communities you serve. Just as naloxone is now 

available in schools, libraries, and other community institutions, naloxone and other opioid 

overdose reversal medications should also be readily available in and around public housing 

settings, multifamily housing programs, housing counseling offices, and programs for people 

experiencing homelessness. Naloxone and other opioid overdose reversal medications should be 

considered a standard part of the toolkit for ensuring health and safety in HUD programs 

alongside carbon monoxide detectors, fire extinguishers, and defibrillators. 

To support these efforts, HUD recently released a fact sheets to public housing authorities 

(PHAs) and owners of HUD-assisted multifamily housing explaining that naloxone can be made 

available to residents. A forthcoming fact sheet for homeless assistance organizations and 

providers of housing and services for people living with HIV will also be released by HUD’s 

Office of Special Needs. These fact sheets also clarify that no applicants or residents of HUDassisted housing should be denied or terminated for the possession or use of naloxone or other 

opioid overdose reversal medications. HUD is encouraging grantees and housing providers to 

keep residents safe and support community-wide public health efforts by ensuring these 

medications are readily available. 
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In addition, to assist in your efforts, at the end of this letter, we include a list of resources related 

to naloxone and other opioid overdose reversal medications, overdose prevention, and innovative 

approaches housing providers and communities have taken to expand access to these medications 

and overdose prevention education and training. 

Thank you for your commitment to these critical issues. Addressing our nation’s overdose crisis 

requires an all-of-community approach. We applaud and encourage your efforts and look 

forward to partnering with you in this critical work moving forward. 

Rachel L. Levine, M.D. 

ADM, USPHS 

Assistant Secretary for Health Department 

of Health and Human Services 

Julia Gordon 

Assistant Secretary and Commissioner 

Department of Housing and Urban 

Development 

Marion McFadden 

Principal Deputy Assistant Secretary 

Department of Housing and Urban 

Development 

Adam W. Cohen 

Deputy Director 

Office of National Drug Control Policy 

Miriam E. Delphin-Rittmon, Ph.D. 

Assistant Secretary for Mental Health 

and Substance Use 

Department of Health and Human Services 

Richard Monocchio 

Principal Deputy Assistant Secretary 

Department of Housing and Urban 

Development 
 

 

 

 

 

 

 

 

 

Resources: 

What is Naloxone 

https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-relatedconditions/naloxone 

Non-prescription (“Over-the-Counter”) Naloxone Frequently Asked Questions 

https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-relatedconditions/naloxone/faqs 

Expanding Access to and Use of Behavioral Health Services for People Experiencing 

Homelessness 

https://store.samhsa.gov/sites/default/files/pep22-06-02-003.pdf 

Resources on harm reduction are available from SAMHSA 

https://www.samhsa.gov/find-help/harm-reduction 

Naloxone and Other Opioid Overdose Reversal Medication Resources 

Naloxone distribution best practices (Harm Reduction Journal, 2022) 

Evaluation Profile for Naloxone Distribution Programs (CDC) 

Information about Naloxone and Nalmefene (FDA) 

Naloxone Insurance Coverage Mandates (NPHL, 2023) 

Provisional Drug Overdose Death Counts (NVSS, 2023) 

Model Expanded Access to Emergency Opioid Antagonists Act (LAPPA, 2021) 

Naloxone Saturation Webinar Series (Opioid Response Network, 2022) 

Nonfatal Opioid Overdose Surveillance Dashboard (NEMSIS, 2023) 

Naloxone and Housing Related Innovations that Mention Naloxone 

Improving Access to Naloxone in St. Louis in Public Housing (2023) 

Healthcare for the Homeless: Teaming up with YES to prevent Opioid Overdose Deaths 

(HCHnews, 2019) 

LA County naloxone distribution among homeless individuals (NCB Los Angeles local news, 

2021) 

Using Hotels/Motels as a COVID-19 Response: Webinar for Formula & Competitive Grantees -

Slides (hudexchange.info) 

COVID-19 Homeless System Response: Justice Partnerships and Reentry Solutions 

(hudexchange.info) 

Infectious Disease Toolkit for CoCs: Preventing and Managing the Spread of Infectious Disease 

within Encampments (hudexchange.info) 

SAMHSA Technical Assistance 

https://www.samhsa.gov/practitioner-training