BACKGROUND AND AIMS: Higher dose naloxone products (HDN) have recently been approved and marketed in the United States; however, evidence on the relative advantage of these products to standard 4 mg products has not been substantiated by prior research. People who use drugs are the primary beneficiaries and consumers of naloxone products. This study aimed to characterize their willingness to use HDN products and technical understanding of these products.
DESIGN AND MEASUREMENTS: We conducted in-depth interviews with syringe service program clients following an interview guide. Interviews were recorded and transcribed before being analyzed using a hybrid deductive-inductive qualitative approach.
SETTING: Interviews were conducted in partnership with community-based syringe service programs in three distinct regions of the state of Maryland, USA: a rural county, Baltimore city and a surrounding suburban community.
PARTICIPANTS: Twenty-two interviews were completed. All participants had used opioids and responded to an overdose using naloxone in the past 3 months. The majority of participants were men (73%), non-Hispanic white (64%) and currently experiencing housing instability (59%).
FINDINGS: Participants demonstrated high willingness to use HDN, motivated by volatility in the local drug supply and perceived inefficiency of naloxone against potent synthetic opioids. Participants believed that the relative advantage of HDN was that it would reverse overdoses more quickly than existing products; however, many participants wanted increased control in overdose situations, including the ability to titrate and combine dosages to reduce the severity of precipitated withdrawal. Skepticism towards HDN products was rooted in general skepticism of pharmaceutical companies, as well as the belief that perceptions of lower dose naloxone being ineffective could be attributed to user error.
CONCLUSIONS: Development of novel overdose reversal products should be informed by the experiences of primary consumers and beneficiaries of these products. A high level of transparency is needed in the marketing of these products to promote consumer trust and confidence in their safety and utility.
‘If you’ve ever experienced it, you’d feel differently’: Exploring willingness and skepticism toward using higher dose naloxone products among people who use drugs in Maryland, United States
Addiction [Epub 2026 Apr 29]. doi: 10.1111/add.70447.