Perceptions surrounding intranasal naloxone use and access among a population experiencing homelessness

Drug overdose is the leading cause of unintentional death in the United States. Studies suggest people experiencing homelessness (PEH) are at higher risk of overdose. Naloxone, trademarked Narcan®, is a medication that can reverse the effects of an opioid overdose. Despite steps taken to increase the availability of naloxone, opioid overdose deaths continue to occur at alarming rates. Few studies have explored naloxone use among PEH, and to the knowledge of the authors, none conducted in the United States have focused on the perspective of this population. The purpose of this study is to describe perceptions of naloxone use and access among PEH.

This was a qualitative study with semi-structured interviews conducted between January 2024 and March 2024. Subjects included adults who met the definition of homelessness per the McKinney-Vento Act and were recruited at a medical clinic within a low barrier shelter. Interview questions were developed using Health Belief Frameworks, and interviews were audio recorded, transcribed, then coded using principles of Grounded Theory to identify themes.

Twelve interviews were conducted. Analysis of the interview transcripts identified themes including distress and misperceptions surrounding substance use, misconceptions about supportive measures following opioid overdose, and wide availability but limited accessibility of naloxone due to physical and social barriers. Participants expressed a desire for training on naloxone and other opioid overdose response measures.

PEH report varying access to naloxone and are conflicted about using the medication. Results of this study will be used to develop programs addressing barriers and promoting facilitators to naloxone use among populations at higher risk for opioid overdose.