Barriers and Facilitators to Naloxone Access for Adolescents: A Narrative Review

Disproportionately high mortality rates from opioid overdose among adolescents have emerged as a major public health concern in the United States (U.S.). Among available interventions, naloxone, an opioid receptor antagonist, continues to be recognized for its effectiveness in reversing opioid overdose. However, access to naloxone among adolescents remains scarce, underscoring potential gaps in overdose prevention for this population.

This narrative review examines current literature to identify barriers and facilitators that influence naloxone availability and uptake among adolescents. The review includes young adult (up to age 30) data when it overlaps with adolescent literature. The review followed the SANRA checklist criteria and utilized the Cochrane, MEDLINE-PubMed, and Google Scholar databases for relevant studies from 2012-2026.

Barriers to naloxone access are multifactorial, including cost-related constraints, inconsistent implementation of over-the-counter dispensing practices, limited awareness of dispensing policies, and stigma towards people who use drugs. Structural and individual factors found to assist in the facilitation of naloxone access include policy changes enabling non-prescription dispensing, pharmacy standing orders, and laws that permit independent minor consent for substance use treatment. However, disparities in naloxone availability and use persist, and implementation of such policies is inconsistent across settings.

Accordingly, legislation that promotes naloxone availability and educational initiatives designed to increase knowledge and acceptance of its use in diverse settings may be important, as evidence supports its association with reduced overdose mortality. Additional efforts are warranted to improve naloxone availability and use among adolescents, including expansion of clinician prescribing practices, reduction of costs at the point-of-dispense, and greater distribution of the medication for patients leaving treatment facilities.