Table 2 Design Considerations and Requirements for OEND toolkit

1. Recognizing an overdose may not be straight forward

• Training should support rapid response,

• Include messaging that naloxone is safe to use in any unresponsive person, and will not cause any harm

2. Responders may not know “how much is enough”

• The kit should be designed so that the responder does not need to make dosing decisions

3. Stigma may reduce the likelihood and pace of response as well as the likelihood of asking for, giving out, and accepting the offer of a kit and training

• An anti-stigma approach in aesthetic choices, language use, and tone, is necessary to reduce potential barriers to response

• The choice of nasal naloxone in take home naloxone distribution kits is suggested to reduce stigma, reduce potential training requirements, and increase likelihood of timely response

4. drug paraphernalia may be both stigmatizing and a potential legal risk to lay responders

• The choice of nasal naloxone in take home naloxone distribution kits is suggested to increase uptake among individuals who may be deterred by needles and ampoules

5. There is a need to move overdose training and response beyond the professional sphere and beyond those immediately at risk who may already be responding and comfortable with needle-based naloxone

• Design choices should position overdose response as a conventional first aid intervention,

6. There is high potential for overdose alone and there is a need to support the option of response by a friend or family member

• The design needs to support sharing with others (both training and kit), recognition as a first aid supply, positioning the kit as part of a safety plan

7. Calling 911 may be thought of as not a “safe” option for those that use drugs and their family and friends

• The training kit should emphasize calling 911, but also support response where 911 is not called