Drug-related death (DRD) is a major public health problem globally, with rates in Scotland higher than any other UK region and among the highest in Europe. One of the most important public health interventions to emerge aimed at tackling rising DRD rates is the distribution of naloxone, the opioid antagonist, for peer administration. The Scottish Government established a national naloxone programme in 2010 aimed at reducing the increasing levels of DRD. The national coverage of the programme is unique by comparison and is an important development in substance misuse public health. This review aims to describe the journey to this landmark public health programme, detailing the research, advocacy and policy contributions that facilitated its creation. The use of naloxone in other countries will also be described, discussing the barriers in place to adopting similar national programmes elsewhere.