Nobody Wants to Be Narcan'd: A Pilot Qualitative Analysis of Drug Users' Perspectives on Naloxone

Jeffrey T. Lai, MD; Charlotte E. Goldfine, MD; Brittany P. Chapman, BSc; Melissa M. Taylor, BA; Rochelle K. Rosen, PhD; Stephanie P. Carreiro, MD; Kavita M. Babu, MD


Western J Emerg Med. 2021;22(2):339-345. 

In This Article

Abstract and Introduction


Introduction: Bystander naloxone distribution is an important component of public health initiatives to decrease opioid-related deaths. While there is evidence supporting naloxone distribution programs, the effects of increasing naloxone availability on the behavior of people who use drugs have not been adequately delineated. In this study we sought to 1) evaluate whether individuals' drug use patterns have changed due to naloxone availability; and 2) explore individuals' knowledge of, access to, experiences with, and perceptions of naloxone.

Methods: We conducted a pilot study of adults presenting to the emergency department whose medical history included non-medical opioid use. Semi-structured interviews were conducted with participants and thematic analysis was used to code and analyze interview transcripts.

Results: Ten participants completed the study. All were aware of naloxone by brand name (Narcan) and had been trained in its use, and all but one had either currently or previously possessed a kit. Barriers to naloxone administration included fear of legal repercussions, not having it available, and a desire to avoid interrupting another user's "high." Of the eight participants who reported being revived with naloxone at least once during their lifetime, all described experiencing a noxious physical response and expressed a desire to avoid receiving it again. Furthermore, participants did not report increasing their use of opioids when naloxone was available.

Conclusions: Participants were accepting of and knowledgeable about naloxone, and were willing to administer naloxone to save a life. Participants tended to use opioids more cautiously when naloxone was present due to fears of experiencing precipitated withdrawal. This study provides preliminary evidence countering the unsubstantiated narrative that increased naloxone availability begets more high-risk opioid use and further supports increasing naloxone access.



Bystander naloxone distribution is an evidence-based public health intervention.[1,2] The Surgeon General of the United States has emphasized the importance of the opioid overdose reversal agent, stating succinctly and unambiguously, "knowing how to use naloxone and keeping it within reach can save a life."[3] However, efforts to enhance naloxone availability have been hampered by stigma surrounding opioid use disorder (OUD), cost and availability issues, and the unproven assertion that naloxone increases high-risk drug use.[4–7] To evaluate perceptions of naloxone uptake and use in our population, we piloted a semi-structured interview developed in conjunction with the National Drug Early Warning System (NDEWS) workgroup.[8]


Although studies have demonstrated that increased availability of naloxone has reduced the rate of opioid overdose fatalities in some communities, there is a paucity of data on whether it has also impacted drug use behaviors. Data regarding knowledge of and attitudes toward naloxone among people who use drugs (PWUD), and the impact of naloxone availability on drug-use behaviors, are urgently needed. In this pilot study, we explored the knowledge and perceptions of naloxone among PWUD in order to obtain more nuanced data to guide public health interventions aimed at decreasing opioid overdose deaths.

Goals of This Investigation

This study sought to 1) explore individuals' knowledge of, access to, experiences with, and perceptions of naloxone; and 2) characterize reported changes in individuals' drug use patterns and attitudes as a result of naloxone accessibility.