Spero Health and Cordant Health Solutions are normalizing what addiction medicine experts have long advocated but too few providers have implemented: making naloxone distribution a routine component of medication-assisted treatment rather than an afterthought. The eight-month initiative, which has already provided the overdose-reversing drug to 486 patients at two Kentucky clinics this summer alone, reflects a pragmatic harm reduction philosophy that acknowledges relapse as a common part of recovery rather than treatment failure requiring exclusion from support.
The partnership pairs Spero Health, one of the nation’s largest office-based opioid treatment providers with more than 45 clinics across five states, with Cordant Health Solutions, a behavioral health solutions company offering drug testing, pharmacies, and analytics focused on addiction treatment. Together, they’ve created an operational model where MAT patients receive naloxone prescriptions filled onsite through Cordant’s managed pharmacy program during routine treatment visits, eliminating the separate steps that often prevent patients from obtaining life-saving medication.
The results reveal both the need and the model’s effectiveness. Four patients at Spero’s largest Kentucky clinic have already used their naloxone to reverse overdoses in friends or loved ones—four lives saved through a simple intervention of ensuring patients leave treatment appointments with medication that can reverse opioid overdoses. The fact that these rescues happened among patients’ social networks rather than the patients themselves underscores how naloxone access creates ripple effects protecting entire communities, not just individuals receiving treatment.
The Harm Reduction Philosophy Behind Routine Naloxone
The initiative rests on acknowledging uncomfortable truths about addiction recovery that some treatment philosophies resist: relapse is common, often multiple relapses occur before sustained recovery, and people experiencing relapse deserve protection from death even when they’re not maintaining complete abstinence. This harm reduction approach prioritizes keeping people alive as the prerequisite for eventual recovery rather than withholding support from those who slip.
Byron Crider, a provider at Spero’s largest Kentucky clinic, articulated this philosophy through a powerful analogy: “Just as we keep a fire extinguisher in our homes should the unthinkable occur, MAT patients should carry naloxone to protect themselves and their loved ones.”
The fire extinguisher comparison reframes naloxone from admission of treatment failure to prudent preparation. Nobody views keeping fire extinguishers as lack of confidence in preventing fires. Similarly, providing naloxone shouldn’t signal doubt about patients’ recovery prospects but rather practical acknowledgment that overdose risk persists and protection makes sense.
This perspective contrasts with treatment approaches that view any substance use during recovery as failure requiring program discharge or that resist harm reduction tools as enabling continued use. The abstinence-only philosophy that has dominated much of addiction treatment history treats relapse as moral failure rather than clinical reality requiring response through continued support and safety planning.
Spero and Cordant’s approach instead treats overdose risk as medical reality requiring medical intervention. Patients receive candid discussions about relapse risk and prevention strategies from clinicians who then ensure they leave with naloxone that could save their lives or others’ lives if overdose occurs.
Daniel Mandoli, Cordant’s president of pharmacy services, emphasized that this focus on naloxone access remains uncommon: “Many providers don’t focus on naloxone as part of addiction treatment, yet research shows that access to naloxone decreases overdose deaths. Delivering naloxone to patients at their office visit through our onsite program ensures they receive it, which is an important step in the process.”
Why Routine Distribution Matters More Than Just Availability
Naloxone has been available for decades, and many states have implemented standing orders allowing pharmacies to dispense it without individual prescriptions. Yet access remains limited because availability doesn’t equal uptake. Multiple barriers prevent people at overdose risk from obtaining naloxone even when technically able to get it.
Stigma creates psychological barriers. Walking into a pharmacy to request naloxone effectively announces opioid use to pharmacy staff and potentially other customers. Many people find this exposure too uncomfortable despite overdose risk.
Cost presents obstacles. While naloxone prices have decreased and insurance often covers it, many patients still face copays or deductibles. For people managing the financial stress common among those with substance use disorders, even modest out-of-pocket costs become barriers.
Logistics matter. Obtaining naloxone separately from treatment requires additional appointments, pharmacy visits, and bureaucratic navigation. When someone is already managing the complexity of MAT—regular clinic visits, medication pickup, counseling appointments, drug testing—adding another task to obtain naloxone becomes one more thing that doesn’t happen amid overwhelming demands.
Knowledge gaps persist. Many patients don’t know naloxone exists, understand that it’s available, or recognize that they should obtain it. Providers who don’t routinely discuss and prescribe naloxone leave patients without information needed to seek it independently.
The Spero-Cordant model eliminates these barriers by making naloxone distribution automatic and integrated into existing treatment visits. Patients have candid discussions with clinicians about overdose risk as routine part of care. Prescriptions are written during appointments. And medication is dispensed onsite through Cordant’s managed pharmacy program, meaning patients leave appointments with naloxone in hand rather than needing separate pharmacy visits.
This integration transforms naloxone from something patients must seek through extra effort into something they receive as standard component of treatment, similar to how patients receiving medications for diabetes or hypertension get prescription refills during routine medical appointments.
The Kentucky Pilot Results and What They Reveal
The fact that 486 patients at two Kentucky clinics received naloxone during just summer months demonstrates significant scale. This wasn’t a small pilot touching a handful of patients but a systematic program reaching hundreds. The throughput indicates that integrating naloxone distribution into routine care is operationally feasible at the volume needed to impact population-level outcomes.
Kentucky represents strategic geography for this initiative. The state has been devastated by the opioid crisis, with overdose death rates well above national averages. Eastern Kentucky particularly—where the two pilot clinics operate—has faced severe impacts from prescription opioid misuse, heroin, and increasingly fentanyl. The region’s history with coal industry decline, economic distress, and limited healthcare access created conditions where opioid addiction took root and spread.
Spero Health’s substantial Kentucky presence—the company operates multiple clinics across the state as part of its 45+ facility footprint—positions it to meaningfully impact state overdose rates through this initiative. If the program expands across all Kentucky locations and then throughout Spero’s five-state footprint, thousands of patients would receive naloxone as routine treatment component.
The detail that four patients used their naloxone on friends or loved ones rather than themselves reveals important dynamics. People receiving MAT often have social networks where active opioid use persists. Friends, family members, and romantic partners may still be using. The MAT patient maintaining recovery becomes potential responder if overdose occurs in their presence.
This network effect multiplies naloxone’s impact beyond individual patients. The 486 patients who received naloxone presumably interact with hundreds or thousands of people across their combined social networks. Each person carrying naloxone creates potential intervention capacity protecting multiple individuals.
The fact that providers like Crider now “regularly check to see who needs refills” indicates the program includes ongoing replenishment rather than one-time distribution. This sustainability ensures patients continue having naloxone available rather than using their supply and not obtaining replacements.
The Operational Model and Why It Works
The Spero-Cordant partnership works because it addresses the full chain from prescription to dispensing that often breaks when these functions are separated. Many treatment programs prescribe naloxone but patients must fill prescriptions at external pharmacies. This separation creates failure points—patients forget, face copays they can’t afford, encounter pharmacies without stock, or simply don’t prioritize the task amid other demands.
Cordant’s managed pharmacy program provides onsite dispensing, eliminating the separate pharmacy visit. Patients receive prescriptions and filled medications during the same treatment appointment. This integration removes logistics as barrier.
The managed pharmacy model also potentially addresses cost barriers. While the press release doesn’t specify cost structures, managed pharmacy programs often negotiate favorable pricing and work with insurers to minimize patient out-of-pocket costs. By controlling both prescribing and dispensing, the program can ensure cost doesn’t prevent patients from receiving naloxone.
The clinical component—candid discussions about relapse risk and prevention—provides context and education that pure naloxone distribution without conversation might lack. Patients understand why they’re receiving naloxone, how to use it, when to call 911, and that having it doesn’t mean providers expect them to relapse but rather that providers want them protected if relapse occurs.
This educational framing helps combat concerns that harm reduction tools enable continued use. By explicitly discussing that naloxone is emergency medication not intended to facilitate ongoing use, clinicians can provide safety tools while reinforcing recovery goals.
Barriers to Broader Adoption and How to Overcome Them
If this model works as effectively as early results suggest, why isn’t it universal across MAT providers? Several barriers impede widespread adoption despite the intervention’s simplicity and low cost relative to overdose deaths prevented.
Provider attitudes shaped by abstinence-only philosophies create resistance. Some treatment programs and clinicians view harm reduction tools as contradicting recovery goals or sending messages that enable continued use. Overcoming these philosophical objections requires education about harm reduction evidence and reframing naloxone as safety measure rather than enabler.
Operational complexity around pharmacy integration stops many providers. Not all treatment programs have relationships with pharmacy partners that can provide onsite dispensing. Building these partnerships, negotiating contracts, managing inventory, and handling insurance billing all require administrative capacity some programs lack.
Reimbursement questions arise. Programs need to understand how naloxone provision is paid—whether through pharmacy benefits, medical benefits, or some other mechanism—and ensure they’re compensated for medication costs and dispensing services. Uncertainty about payment can deter adoption.
Regulatory and licensing requirements vary by state. Some jurisdictions may have rules affecting onsite pharmacy operations or naloxone prescribing that complicate implementation. Navigating these variations requires legal and regulatory expertise.
Naloxone supply and pricing fluctuate. While prices have generally decreased, supply shortages have periodically affected availability. Programs need reliable naloxone sources at predictable prices to sustain distribution.
Overcoming these barriers requires advocacy from medical associations and regulatory bodies to establish best practices calling for routine naloxone provision, technical assistance helping programs establish pharmacy partnerships and navigate operational challenges, and payment policy reforms ensuring adequate reimbursement for naloxone provision as part of MAT.
The Broader Context of Overdose Deaths and Naloxone Access
The Spero-Cordant initiative launched against backdrop of worsening overdose crisis. Provisional CDC data showed over 90,000 drug overdose deaths in 12-month period ending September 2020—the highest number ever recorded and 28% increase from the previous year. The surge correlates with COVID-19’s isolation, economic stress, disrupted treatment access, and increasingly contaminated drug supply with high-potency fentanyl.
In this context, expanding naloxone access becomes urgent public health priority. Every person carrying naloxone represents potential life-saving intervention if overdose occurs. Multiplying the number of people equipped to respond to overdoses through systematic distribution at treatment sites could prevent thousands of deaths.
Research consistently demonstrates that naloxone access reduces overdose mortality at population level. Communities with broader naloxone distribution see fewer overdose deaths. Yet despite this evidence, naloxone remains inadequately distributed relative to the scope of overdose risk.
Many people who die from overdoses were not currently engaged in treatment. However, people receiving MAT often have connections to active users in their social networks. Equipping MAT patients with naloxone potentially reaches populations not accessing formal treatment through social connections.
Why This Model Should Spread
The Spero-Cordant program offers a template other MAT providers could adapt to their contexts. The core principles—integrating naloxone provision into routine care, providing onsite dispensing, ensuring cost doesn’t create barriers, and framing naloxone as standard safety measure rather than admission of failure—can be implemented regardless of specific operational details.
For large MAT providers like Spero with multi-state footprints, systematizing naloxone distribution across all locations would reach tens of thousands of patients. For smaller independent providers, even ensuring dozens or hundreds of patients carry naloxone makes meaningful local impact.
The pharmacy partnership model Spero and Cordant created could be replicated through relationships with other pharmacy services companies or through health system-owned pharmacies for MAT programs affiliated with hospitals.
State Medicaid programs and commercial insurers should consider requiring naloxone provision as standard component of MAT coverage. If payment policies specify that evidence-based MAT includes naloxone distribution, providers would have financial incentives to implement systematic programs rather than ad hoc approaches.
Federal grant programs funding MAT expansion could require or incentivize naloxone distribution as condition of funding. The Substance Abuse and Mental Health Services Administration’s grants supporting opioid treatment programs could stipulate that recipients must provide naloxone to patients.
Looking Beyond MAT to Other High-Risk Populations
While the Spero-Cordant initiative focuses on MAT patients, the model has potential application to other populations at overdose risk. People leaving incarceration face extremely high overdose death rates in the days and weeks following release as they encounter street opioids after periods of reduced tolerance. Systematic naloxone provision at release could prevent many of these deaths.
Hospital emergency departments treating overdose survivors or people with opioid use disorder could provide naloxone at discharge rather than just giving patients referral information and hoping they obtain it elsewhere.
Pain management clinics prescribing opioids for chronic pain could provide naloxone to patients as safety measure, particularly for those taking high doses or with concerning risk factors.
Syringe service programs already distribute naloxone extensively, but systematizing training and ensuring every participant receives adequate supply would expand impact.
Each of these settings presents opportunities to normalize naloxone provision as standard safety measure for anyone at risk rather than treating it as special intervention requiring extra effort to obtain.
The Message This Sends
Perhaps most importantly, routine naloxone distribution as part of MAT sends powerful messages that help combat stigma and misconceptions about addiction treatment.
To patients, it communicates that providers view them as worthy of protection, that relapse doesn’t mean abandonment, and that staying alive matters more than maintaining perfect adherence to recovery goals.
To families, it signals that evidence-based treatment includes safety planning for worst-case scenarios rather than pretending relapse never happens or is unworthy of preparation.
To the public, it demonstrates that addiction treatment has evolved beyond simplistic abstinence-only models to embrace harm reduction as complement rather than contradiction to recovery goals.
To policymakers, it offers concrete example of how medical interventions can prevent overdose deaths if systematically deployed at scale.
The fire extinguisher analogy Crider used captures this messaging perfectly. Nobody views keeping fire extinguishers as abandoning fire prevention or enabling arson. Similarly, providing naloxone shouldn’t be viewed as abandoning recovery goals or enabling continued use but rather as prudent safety measure acknowledging that emergencies can occur despite best prevention efforts.
What Success Looks Like Going Forward
If the Spero-Cordant initiative succeeds and expands, several outcomes would indicate impact. The program should scale across all Spero Health locations rather than remaining limited to initial pilot sites. The 486 patients at two Kentucky clinics should grow to thousands of patients across the five-state footprint receiving naloxone as routine care component.
Documented overdose reversals using naloxone distributed through the program would provide evidence of lives saved. Tracking how many patients or their social network members use naloxone successfully would quantify impact.
Other MAT providers adopting similar models would signal that the template is replicable and valuable. If competitors see Spero’s approach and implement their own systematic naloxone programs, the intervention would spread organically through demonstration effects.
Reduced overdose death rates in communities where Spero operates, particularly if compared to similar communities without systematic naloxone distribution, would provide population-level outcome evidence.
For now, the early results—486 patients provided naloxone at two clinics, four documented uses saving lives—demonstrate that integrating naloxone distribution into MAT is operationally feasible and clinically valuable. Whether this pilot expands into standard practice across addiction treatment will depend on continued execution by Spero and Cordant, adoption by other providers, and policy changes that incentivize or require naloxone provision as part of evidence-based MAT.
In a year when overdose deaths reached historic highs and COVID-19 worsened an already devastating crisis, innovations that prevent even some of those deaths deserve attention and replication. The Spero Health and Cordant Health Solutions partnership demonstrates that sometimes the most impactful interventions aren’t complex new treatments but rather systematic implementation of existing tools we already know work. The challenge isn’t discovering what to do—it’s actually doing it at the scale needed to save lives.
