Naloxone Carriage Among People Who Inject Drugs in New York City.

Introduction: Naloxone carriage allows for timely use to reverse opioid-involved overdoses. This study seeks to determine the prevalence of naloxone carriage, as well as associated factors, among people who inject drugs in New York City.

Methods: Using respondent-driven sampling, people who inject drugs across New York City were recruited to complete a cross-sectional survey between 2021 and 2024. Naloxone carriage was defined as self-reporting naloxone carriage 'most of the time' or 'always'. Variables related to demographics, substance use, overdose, treatment history, syringe source and prior naloxone experience were included. Data were analysed using bivariable and multivariable logistic regression.

Results: In this sample of 361 participants, 162 (45%) reported naloxone carriage. The majority of participants were male (71%; n = 258) with an average age of 48.48 (SD 10.23). The odds of carrying naloxone were significantly higher among those who experienced recent food insecurity (adjusted odds ratio [aOR] 2.18; 95% confidence interval [CI] 1.34, 3.56), reported fewer years of injection drug use (aOR 1.03; 95% CI 1.01, 1.05), used naloxone to reverse someone else's overdose (aOR 2.54; 95% CI 1.56, 4.14), received syringes from a syringe service program (aOR 3.33; 95% CI 1.61, 7.14), and used test shots as an overdose prevention strategy (aOR 2.55; 95% CI 1.33, 3.56).

Discussion and conclusions: While a higher prevalence than other studies, less than half the sample reported naloxone carriage. There are modifiable factors that can increase naloxone carriage at the individual level. However, given the low prevalence of naloxone carriage, there is a need for further intervention, particularly at the systemic level.