USC study sheds light on nationwide naloxone awareness and use

A new USC-led study provides the first nationwide picture of who knows about, carries, and uses naloxone to reverse deadly opioid overdoses.

Mireille Jacobson, professor of gerontology at the USC Leonard Davis School of Gerontology and a senior fellow at the USC Schaeffer Center for Health Policy & Economics, said the study was conducted to address the lack of comprehensive data on access to the lifesaving medication and eventually to support work on how it affects the number of deaths attributed to opioid overdoses in the U.S.

There have been many analyses of how new policies, including naloxone becoming available through pharmacy dispensation, correlate with reductions in opioid deaths, but we don't know exactly how much of the improvement is directly due to naloxone use versus any of the various other things being done to address this crisis at the same time. We don't really have any data on who knows what naloxone is for, carries it, and administers in the case of an overdose. We're trying to fill in a missing link."

Mireille Jacobson, professor of gerontology, USC Leonard Davis School of Gerontology

Addressing an epidemic

In the study, Jacobson and coauthor David Powell, a senior economist at RAND, note the critical need to tackle the ongoing opioid crisis, which has had profound effects in the U.S, and understand the impacts of measures intended to address the devastating rate of overdose deaths.

Of the more than 100,000 drug overdose deaths that occurred nationwide in 2023, more than 75% of them involved opioids, according to data from the Centers for Disease Control and Prevention. Previous USC Leonard Davis School research has also shown how opioid overdose deaths have contributed to the widening gap in life expectancy between the United States and other high-income countries.

Since 2023, naloxone has been available over the counter, in hopes that wider availability would encourage more people to have the drug at the ready to save the life of someone overdosing. However, the lack of reliable, nationwide data on who was buying, carrying, and using naloxone has hindered research on how to best prevent overdose deaths, Jacobson said.

"With the problem being so widespread, one question is how to most effectively manage this crisis," she said. "To know where to put our resources, we need to know about the actual ways this medication gets to the people who will use it. Our goal was to fill in the data and allow people to understand the mechanisms."

Online surveys shed light

In June 2024, Jacobson and Powell conducted an online survey of two groups of participants. The first group was a nationally representative sample of 1515 people over the age of 18 not living in an institutional setting, while the second group contained 512 individuals who reported currently or ever having opioid dependence. Additionally, 50 respondents, or 3.3%, from the national sample also reported opioid dependence, bringing the total number of people reporting their own dependence on opioids to 562.

From the nationally representative sample:

• 700 (46.2%) reported having heard of naloxone and correctly identified it as a drug to reduce opioid overdoses.
• 160 people, or 10.6%, said they carried naloxone with them.
• 128 people (8.4%) said they had administered naloxone to someone else, while 93 respondents (6.1%) said they had been administered naloxone themselves.

Among the 562 individuals reporting current or prior opioid dependence:

• 500 people (89%) had heard of naloxone and knew its purpose.
• 340 respondents (60.5%) reported carrying naloxone.
• 267 (47.5%) reported administering the drug to someone else, and 221 (39.3%) said naloxone had been administered to them.

The survey also showed that a person's perception of the risk of overdose, either for themselves or for someone they know, correlated with the choice to carry naloxone. Of the survey respondents in the national sample who reported themselves as "very likely to overdose," 31% carried naloxone, and in the sample of people reporting opioid dependence, nearly 74% of those who said they had a high likelihood of overdosing carried the drug. The likelihood of carrying naloxone followed a similar pattern among those who stated that they knew someone else who was very likely to overdose.

Another notable finding concerned how people obtained the naloxone they carried. Among those who have ever carried naloxone, only 42% of those in the national sample, and just 22.6% of those who reported opioid dependence, said they purchased the medicine themselves. These results highlight the problem with estimating naloxone availability based on pharmacy sales, as it excludes the hospitals, clinics, and other community organizations who give the drug away for free, Jacobson explained.

Next steps

While the data provides some of the first nationwide insights on who has and uses naloxone, this is just a starting point for future research, Jacobson said.

She explained that she's eager for the results to be examined and validated in other larger, more robust surveys, including in the USC Understanding America Survey. Ideally, future study will uncover the best ways to teach people about naloxone and the most efficient avenues to get the drug to the people who will use it to save lives.

"The hope is that we can look at this more longitudinally and in more detail," Jacobson said.