Published: 08/5/2026 | Author: Terri

Naloxone reverses opioid overdose. It works in minutes, requires no medical training, and costs a fraction of an ambulance ride. Yet in a new analysis of more than 3,000 people in rural areas affected by opioid addiction, only 36% had it.

Dr. P. Quincy Moore headed a team based at the Permanente Medical Group in Oakland, California. While The Golden State has a wide range of inpatient programs, naloxone distribution sites, and local organizations like Narcotics Anonymous, the report’s findings concerning the limited access to naloxone in rural areas reminds us that gaps exist in addiction treatment programs, even in the same state.

The Opioid Crisis in Rural Areas

Researchers analyzed cross-sectional data from the Rural Opioid Initiative. This multisite consortium spans eight study sites in rural counties across 10 states. Over 3,000 participants aged 15 and older took part, with a mean age of 36.1 years, and 57% were men. All self-reported any opioid use to get high or drug injections in the past 30 days. Recruitment ran from January 2018 to March 2020.

Participants also filled out surveys covering drug use behaviors, access to injection equipment and health care, safer injection practices and awareness of harm reduction services.

Just over one in three had naloxone.

Naloxone Possession

Three factors stood out as associated with higher naloxone possession. Injection drug use was one. A history of overdose was another. The third was receiving syringes from harm reduction programs or from treatment.

The direction of that last finding is worth sitting with. People who had contact with a harm reduction or treatment program had a greater chance of carrying the paraphernalia that keeps them alive. Distribution infrastructure and Good Samaritan Laws are working as intended, and the shortfall concerns reach rather than in willingness.

Since this is cross-sectional data, the analysis identifies associations rather than causes. A prior overdose was linked to naloxone possession, but the study design can’t establish that the overdose itself prompted someone to obtain it.

“This disparity in naloxone possession by high-risk, rural people who use drugs highlights the need for improved infrastructure for naloxone distribution in rural areas,” the authors wrote.

Study Limitations

Some differences arose in how participants enrolled across the study sites. In addition, the researchers didn’t measure how frequently respondents who reported having naloxone actually carried it with them. In some cases, folks kept naloxone at home rather than having it during drug use, which means real-world protection may be lower than the 36% figure suggests.

Funding for the data collection came from the National Institute on Drug Abuse, the Appalachian Regional Commission in Appalachia, the CDC and SAMHSA.

Opioids and Naloxone

Opioids include prescription medications along with heroin and fentanyl. They slow breathing, which makes overdose fatal. Fentanyl is far more potent than heroin and dominates the illicit drug supply, including in counterfeit pills and in stimulants, so people who don’t intend to use opioids at all often encounter them.

Naloxone, sold as Narcan and in generic nasal spray form, temporarily reverses that respiratory depression. It has no effect on someone who hasn’t taken opioids, can’t be misused, and can be given by a bystander. Due to fentanyl’s potency and long active life within the body relative to a single naloxone dose, those administering naloxone sometimes need to give more than one dose. Always call emergency services.

Naloxone is one piece of a larger set of options. Medication for opioid use disorder, including buprenorphine, methadone and naltrexone, is the most strongly evidence-supported treatment for opioid addiction and substantially lowers overdose risk. 

Fentanyl test strips let people check a supply before use. 

Syringe services programs reduce transmission of HIV and hepatitis C. As this study reflects, syringe swap sites function as a distribution point for naloxone.

Peer support has its own role. Narcotics Anonymous meetings give people in recovery from drug addiction a free, widely available place to connect with others working through the same thing. NA and medication treatment are not competing choices, and many people use both.

NA a Starting Point to Fight Opioid Addiction

If you or someone close to you uses opioids, get naloxone before you need it. Most states allow pharmacy purchase without a prescription, and many health departments, syringe services programs and community organizations distribute it free.

To find fellowship, even if just a shoulder to lean on during hard times, NA remains a strong choice. Search our online directory for meetings in your state and city, including virtual and Zoom meetings, which matter in rural areas where the nearest in-person meeting may be an hour away. 

To find opioid treatment programs and medication providers near you, or to talk through options confidentially at any hour, call 800-934-1582(Sponsored) to speak with an expert. For a mental health or overdose-related crisis, call 988.