Having naloxone when you need it: Factors associated with owning and carrying naloxone among people who use opioids

It is critical to have naloxone readily available in the event of an opioid overdose. This study examines the prevalence of owning and carrying naloxone and factors associated with ownership and carriage among people who use opioids in Baltimore, Maryland, from December 2022 to January 2025. Among the 780 community-recruited study participants who were aged 18 years or older and currently used non-prescription opioids, most (78.2 %) reported owning naloxone, with the majority (69.4 %) keeping it at their residence. While 41.8 % of participants reported always having naloxone available when using drugs, 13.5 % never did. Only 27.0 % were carrying it with them at the time of the interview. Frequent heroin/fentanyl use (aOR: 2.07; 95 % CI: 1.36–3.16) and reporting lower difficulty accessing naloxone (aOR: 2.37; 95 % CI: 1.85–3.05) significantly increased the likelihood of owning naloxone. Experiencing homelessness in the past six months (aOR: 2.09; 95 % CI: 1.40–3.12) and perceiving poor neighborhood treatment due to drug use (aOR: 1.27, 95 % CI: 0.1.08–1.49) increased odds of currently carrying naloxone. Although naloxone distribution programs have successfully improved access, substantial gaps remain in consistent naloxone carriage, necessitating targeted interventions addressing barriers to carriage, including drug use stigma.