Naloxone Knowledge, Carrying, Purchase, and Use.

Importance: Widespread naloxone access is a key policy response to the opioid crisis. Naloxone availability is typically estimated from pharmacy sales, which exclude naloxone provided by community organizations, hospitals, and clinics, or sold over-the-counter.

Objective: To estimate naloxone knowledge, carrying, purchase, and use among US adults.

Design, setting, and participants: This survey study included noninstitutionalized adults aged 18 years and older from a national sample and a sample self-reporting opioid dependence. Respondents answered online questions between June 7 and June 29, 2024, about naloxone knowledge, carrying, purchase, and use.

Exposures: Opioid misuse, risk of overdose, risk of overdose by person known to respondent.

Main outcomes and measures: Naloxone knowledge, prevalence of naloxone carrying, purchase, and administration.

Results: The survey included 1515 individuals from a national sample (median [IQR] age, 45 [33-58] years; 770 women [50.8%]; 215 Black [14.2%], 1087 White [71.8%]) and 512 who self-reported opioid dependence. In the national sample, 50 respondents (3.3%) reported opioid dependence, yielding 562 respondents reporting opioid dependence (median [IQR] age, 41 [35-48] years; 404 female [70.2%]; 17 Black [3.0%], 494 White [87.9%]). Overall, 1164 respondents-700 (46.2%) in the national sample and 500 (89.0%) reporting opioid dependence-had heard of naloxone and correctly identified its purpose. One hundred sixty participants (10.6%) in the national sample and 340 participants (60.5%) in the sample reporting opioid dependence reported carrying naloxone. Among those reporting they were "very likely to overdose," 22 respondents (31.0%) in the national sample and 31 (73.8%) with opioid dependence reported carrying naloxone. Among those who know someone very likely to overdose, 43 participants (25.4%) in the national sample and 190 participants (70.1%) reporting opioid dependence reported carrying naloxone. Among those who ever carried naloxone, 108 (42.4%) in the national sample and 97 (22.6%) reporting opioid dependence had ever purchased naloxone. Overall, 128 respondents (8.4%) in the national sample and 267 respondents (47.5%) reporting opioid dependence reported administering naloxone to someone else while 93 (6.1%) in the national sample and 221 (39.3%) reporting opioid dependence reported being administered naloxone.

Conclusions and relevance: In this survey study of naloxone, most respondents reporting opioid dependence correctly identified naloxone's purpose and carried it. Most naloxone carried was not purchased, suggesting a need for new ways, including rapid online surveys, to monitor naloxone possession.