Knowledge, access, and possession of naloxone (Narcan) among U.S. adults: A nationwide survey 2023.

Abstract

Background and objectives: Opioid toxicity remains a significant public health issue in the United States, with naloxone serving as a key intervention to reverse toxicity effects. This study aims to identify demographic predictors across the naloxone cascade-a framework comprising awareness, beliefs, access, availability, and possession of naloxone-among U.S. adults, using data from the National Center for Health Statistics Rapid Survey System.

Methods: We conducted a cross-sectional survey of U.S. adults aged 18 and older (n = 7046, weighted total = 257,926,944 representing the U.S. adult population) between October to November 2023. Multivariable logistic regression analyses identified predictors across each naloxone cascade, adjusted for age, sex, education, race, and poverty status.

Results: Awareness of naloxone was high (75.1%), but only 53.2% were aware of its availability over-the-counter, and 5.6% reported carrying it. Female participants showed higher awareness (OR: 1.29; 95% CI: 1.12-1.48), while participants aged 60 years and over were significantly less likely to carry naloxone (OR: 0.55; 95% CI: 0.32-0.94). Significant disparities observed across racial and socioeconomic groups, with Non-Hispanic Blacks and Hispanics had lower awareness levels than Non-Hispanic Whites.

Discussion and conclusions: Despite high awareness, naloxone possession remains low, especially among older adults and racial minorities. Tailored public health interventions are needed to improve naloxone distribution and accessibility in underserved populations.

Scientific significance: This study identified important demographic predictors and gaps in naloxone possession across U.S. adult populations, offering insights to inform public health strategies to reduce opioid toxicity deaths.