ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2026
Correlates of Rural Naloxone Possession Among People Who Use Drugs: A Multi-State Cross-Sectional Analysis.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeNaloxone administration by laypersons is proven to reduce opioid overdose mortality. Despite legislative advances, people who use drugs (PWUD) in rural settings face unique barriers to naloxone possession. This study aims to examine naloxone possession and identify its correlates among a large, geographically diverse sample of people who either use opioids or inject drugs in rural areas.
methodsWe performed a cross-sectional analysis using Rural Opioid Initiative (ROI) data from rural counties of ten US states. Study sites administered a harmonized survey instrument of 3048 PWUD recruited from January 2018 to March 2020. The primary outcome was current naloxone possession. Potential correlates were identified through review of the literature. Data were collected on demographics, drug use behaviors, overdose experiences, access to care, and addiction treatment. Data were analyzed using descriptive statistics, bivariate associations, and multivariable prevalence ratios.
findingsAmong 3008 participants included in the analysis, 36.4% reported possessing naloxone. Naloxone possession was associated with younger age, illegal income sources, past 30-day opioid use, personal history of overdose, witnessing an overdose, knowing someone who died from an overdose, current injection drug use, and receiving syringes from syringe service programs (SSPs). No association was found between access to care and naloxone possession.
conclusionsOnly 36% of high-risk rural PWUD possessed naloxone. Factors such as injection drug use, overdose history, and SSP access increased the likelihood of naloxone possession. These findings highlight the need for targeted naloxone distribution strategies in rural areas, considering the unique barriers faced by rural PWUD.
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