| Sumario: | This qualitative case study examines how frontline employees within local public health units (LPHUs) interpret and implement a video-enabled naloxone distribution intervention across North Dakota, a largely rural state. Semi-structured interviews were conducted with 20 representatives from 17 LPHUs that implemented ONEboxes®, portable opioid overdose reversal kits containing nasal naloxone, personal protective equipment, and an embedded instructional video. Using an inductive, teambased coding process, five primary themes were identified: impacts, successes, challenges, promotion, education tactics, and community reactions. Participants described ONEboxes® not only as overdose reversal tools but also as mechanisms for community education regarding harm reduction efforts such as naloxone interventions, stigma reduction towards opioid use and overdose, and empowerment of community members. The embedded instructional video was viewed as critical in increasing bystander confidence and reducing hesitation during emergencies.
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