People entering opioid substance use treatment have low rates of naloxone knowledge and possession.

Background And Aims: Deaths from opioid overdose are increasing in the United States (US) and distribution of the opioid antagonist naloxone is one key strategy to reduce mortality. In this cross-sectional survey, we assess the association of high-risk behaviors with possession of naloxone and knowledge of where to find it.

Setting And Participants: 5663 adults entering treatment for opioid use disorder at facilities throughout the US during the calendar year 2022 were surveyed.

Analysis: Using a logistic regression analysis, we compared self-reported ownership of naloxone and knowledge of where to find naloxone between individuals with different self-reported types and routes of opioid use, as well as those with a history of opioid overdose compared to those without.

Findings: Patients reporting fentanyl, heroin, and more than one type of opioid use had higher rates of naloxone possession than those reporting oxycodone use alone. Patients that reported injection drug use were more likely to possess (61 %) and know where to get (77 %) naloxone than those who did not inject drugs (44 % possessed and 58 % knew where to find naloxone, p < 0.001 for each comparison). Patients with a self-reported history of overdose were more likely to possess (59 %) and know where to get (77 %) naloxone than those without a history of overdose (42 % and 55 % respectively, p < 0.001 for each comparison).

Conclusions: Gaps in naloxone possession and knowledge persist amongst patients entering treatment for opioid use disorder. Additional efforts to expand naloxone ownership are critical, including comprehensive educational programs, involvement of community-based organizations, and bystander training.