"All You Can Do is What You Know to Do": Naloxone Knowledge and Uncertainty Among People Who Use Drugs in Maryland amid a Volatile Drug Market.

UNLABELLED

Community-based distribution of naloxone has continued to serve as an important strategy in combatting the U.S. opioid overdose crisis. People who use drugs are first responders in this crisis, administering and disseminating knowledge about naloxone among their social networks. However, it is unclear how knowledge of naloxone evolves over time and across individuals, especially amid a volatile, unregulated drug market.

OBJECTIVES

We conducted 22 qualitative interviews with people who use drugs in rural, suburban, and urban regions of Maryland. Interviews focused on respondents' experiences witnessing and experiencing overdose, reversing overdoses with naloxone, and sources of uncertainty in overdose response.

RESULTS

Participants demonstrated high willingness and capacity to respond to overdose using naloxone. However, limited technical knowledge about naloxone contributed to riskier overdose reversal strategies, especially among individuals who had not received formal training. Non-naloxone reversal strategies, such as rescue breathing, were not widely used by participants. Finally, perceived volatility within local drug markets, specifically fentanyl analogues and xylazine, undermined participants' confidence in the effectiveness of naloxone.

CONCLUSION

People who use drugs serve an important role in community-based overdose reversal. Leveraging their experiential knowledge of overdose with technical knowledge of naloxone is foundational to effective community-based naloxone dissemination. Harm reduction programs should ensure that educational materials describe technical aspects of overdose response in ways that are intuitive to the experiences of people who use drugs, as well as ensure materials are responsive to an evolving drug supply.