The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City

•Role of pharmacy-distributed naloxone in population-level overdose death is unknown.•We linked pharmacy and community distributed naloxone to overdose and community data.•Level of naloxone distribution, not change, was associated with fatal overdose.•Naloxone is going to the communities that need it, but current volume is insufficient.•Require additional prevention, treatment, recovery, and harm reduction interventions.