Article submitted by:
Alyssa Hodges, MPH, TTS
PharmD Candidate 2026
In recent years, the opioid crisis has proven to be an increasing challenge across the United States as we combat the misuse of both prescription and illegal opioids. This has negatively impacted communities across the nation. In response to this pressing issue, NDSU’s Opioid and Naloxone Education (ONE) Program was designed to be a crucial player in this battle within North Dakota. The ONE Program innovatively partnered with local public health units across North Dakota to strategically install ONE boxes, significantly improving the accessibility of naloxone throughout the state.
Figure 1. Contents of ONE Box
Each ONE box (Figure 1) includes two doses of naloxone, a CPR kit, and plays an instructional video providing clear steps for a bystander to assist and rescue a person suffering from an opioid overdose. This educational component is a crucial piece of the ONE box as it empowers members of the community, assumed to have little to no knowledge of how to save someone during an overdose, with the knowledge and confidence needed to intervene effectively in emergency situations.
The ONE Program recognizes the embedded position of local public health units (LPHUs) and asked each determine where to place ONE boxes in their communities. ONE Program encouraged LPHUs to brainstorm where members in their community tend to gather, taking into special consideration locations accessible after normal business hours. Due to the variability of communities throughout the state of North Dakota, a variety of locations have been used to maximize accessibility, including: schools, churches, libraries, bars, campgrounds, golf courses, community centers, hockey arenas, city buildings (such as the courthouse, city hall, social services, the post office), fairgrounds, recovery centers, retail stores (such as thrift stores, convenience stores, and grocery stores), assisted living facilities, fire departments, employers of shiftwork, tribal buildings, counseling centers, hotels, and agriculture elevators. The LPHUs collaborate with their community locations to provide training, stock the boxes with naloxone, and monitor for replacement needs.
As of July 2024, over 500 ONE Boxes have been dispersed across the state. By placing ONE boxes in local facilities in communities across North Dakota, the impact of the ONE Program begins to extend past the increased access to naloxone. Simultaneously, there is a notable effort to destigmatize opioid misuse and accidental overdoses, along with advocating for safe medication use and available community resources.
The map below (Figure 2) depicts all locations of ONE boxes placed by LPHUs serving as a testament to the collective effort of local public health units, North Dakota’s Department of Health and Human Services, the ONE Program and key stakeholders across the state who are committed to combating the opioid crisis within North Dakota.
In conclusion, the ONE Program has fostered a collaboration with local public health units to develop an approach to the opioid crisis that prioritizes the ability to access naloxone amidst an emergency that requires timely action. As the ONE Program continues to expand its impact, it serves as a model to demonstrate that through united efforts and strategic initiatives, we can empower our community members to aid in the opioid epidemic battle and potentially help save a life.
Figure 2: Locations of ONE Boxes in Communities Across North Dakota
In response to the rising opioid problem, faculty members at the NDSU School of Pharmacy and other partners introduced the ONE Program. The purpose of the ONE Program is to equip pharmacists with tools to screen for opioid use disorder to identify patient needs and provide counseling and support to assist them in safely using prescribed opioids.