TOPLINE

Among more than 3000 people living in rural areas who used opioids or injected illegal drugs, 36% possessed naloxone. The use of injection drugs, a history of overdose, and the receipt of syringes from harm reduction programs or treatment were associated with higher naloxone possession.

METHODOLOGY

• Researchers analyzed cross-sectional data from the Rural Opioid Initiative, a multisite consortium spanning eight study sites in rural counties across 10 states.
• A little over 3000 participants aged 15 years or older (mean age, 36.1 years; 57% men) who self-reported using any opioid to get high or injecting any drug in the past 30 days were recruited from January 2018 to March 2020.
• Participants completed a survey of drug use behaviors, access to injection equipment and healthcare, safe drug injection practices, and the use of harm reduction services, among others.
• The primary outcome was whether participants currently had naloxone with them or at home and associations between naloxone possession and past 30-day drug use, overdose experience, and treatment for addiction were assessed.

TAKEAWAY

• More than one third of the participants reported they currently had naloxone, and 86% reported past-month opioid use. Those who possessed naloxone were more likely to report 30-day opioid use (93% vs 82%) and more frequently used opioids (mean, 19.6 days vs 13.5 days).
• Personal history of overdose was associated with naloxone possession (adjusted prevalence ratio [aPR], 1.47; P < .001), as was ever witnessing someone overdose (aPR, 1.97; P < .001).
• Current use of injection drugs was associated with increased naloxone possession (aPR, 1.53; P < .001); use of syringe service or needle exchange programs as the main source of syringes or needles in the past 30 days was also associated with naloxone possession (aPR, 1.72; P < .001).
• Receiving medication for opioid use disorder and treatment in the previous month was associated with having naloxone. No significant association was found with access to healthcare.

IN PRACTICE

“This disparity in naloxone possession by high-risk, rural people who use drugs highlights the need for improved infrastructure for naloxone distribution in rural areas,” wrote the authors of the study.

SOURCE

The study was led by P. Quincy Moore from the Department of Emergency Medicine at the Permanente Medical Group in Oakland, California. It was published online on July 25, 2026, in the Journal of Rural Health.

LIMITATIONS

There were differences in how participants were enrolled across various study sites, with minor variations in the criteria for inclusion. The study did not measure how frequently respondents who reported naloxone possession carried it with them; some may have had it at home but not had it easily accessible during drug use.

DISCLOSURES

Primary data collection was supported by various grants co-funded by the National Institute on Drug Abuse, the Appalachian Regional Commission, the CDC, and the Substance Abuse and Mental Health Services Administration. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.