Factors Associated with Knowledge of Naloxone Dispensing Sites: Implications for Overdose Prevention Efforts

Background and Purpose:
Opioids are the main driver of overdose deaths in the U.S. (Hadland et al., 2021). One strategy to prevent opioid overdose deaths is increasing layperson access to naloxone, the opioid antagonist medication that can reverse the effects of an opioid overdose when administered emergently. However, some research suggests naloxone distribution efforts may not be reaching target populations (Heavey et al., 2018). Using a general population sample, this study investigated factors associated with knowledge of naloxone dispensing sites overall, and through various community dispensers.

Methods:
Adults living in Michigan (N=823) were recruited by Qualtrics from an online research panel (June-July 2022). Participants self-reported their age, gender identity, racial-ethnic identity, and education. Surveys assessed knowledge of Michigan’s standing order law, past-year nonmedical opioid use (NMOU), personal connection to NMOU, and abstinence orientation. Participants responded to one open-ended item, indicating where in their community they could get naloxone. Responses were coded to indicate whether the participant knew where to get naloxone, and if so, where. Multiple logistic regression was conducted in Mplus version 8.3 to identify factors associated with overall knowledge of where to get naloxone, and four commonly identified dispensing sites: pharmacies, prescribers, community organizations, and the police.

Results:
Overall, 64.1% knew where to get naloxone (n=501; pharmacies=242, prescribers=165, community organizations=45, police=70). Older age (OR=.988, p=.011) and greater abstinence orientation (OR=.785, p=.002) were associated with lower odds of knowing where to get naloxone; knowledge of the standing order law (OR=1.631, p=.002) and knowing someone with a history of NMOU (OR=1.383, p=.044) were associated with greater odds of knowing where to get naloxone. Knowledge of pharmacy dispensing was less likely among older individuals (OR=.986, p=.018) and more likely among those who knew of the standing order law (OR=2.465, p<.001). Knowledge of prescriber dispensing was more likely among older individuals (OR=1.014, p=.023) and less likely among those who knew of the standing order law (OR=.396, p<.001). Individuals with past-year NMOU (OR=2.338, p=.032) and those who knew someone with a history of NMOU (OR=2.439, p=.026) were more likely to indicate community organizations as a source of naloxone. Knowledge of police dispensing was more likely among older individuals (OR=1.019, p=.023) and less likely among Black individuals (OR=.081, p=.001) and other people of color (OR=.299, p=.029), compared to their white counterparts.

Conclusions and Implications:
Most adults in this general population sample knew where to get naloxone. Those who knew someone with a history of NMOU demonstrated greater knowledge of where to get naloxone overall. Findings provide direction for allocating limited resources in order to reach target populations. Education about standing order laws may help increase awareness of convenient pharmacy dispensing locations. Distribution through community organizations emerged as an effective strategy for reaching people who use opioids and their friends and family members. Police department distribution may not be reaching people of color. Future research should examine changes in naloxone knowledge and access within the context of the recent FDA approval for over-the-counter naloxone.