Discussion
overdose
This study qualitatively assessed the pathways through which risk environments influence how rural PWUD accept, carry, and administer naloxone, and the role of an OEND intervention on these experiences. Analyses found that the C2H OEND intervention altered some participants’ healthcare environments by providing access to naloxone, increasing participants’ knowledge of naloxone efficacy and administration technique, and increasing some participants’ confidence in naloxone administration. Over half of participants gained knowledge on naloxone through the intervention related to the healthcare environment (how to access naloxone, administration technique) and political/law enforcement environment (medical amnesty policies). Through knowledge and skills gained in the intervention, participants became a part of their local healthcare environment: most participants opted to carry naloxone, citing factors related to the social environment (responsibility to community) and physical/healthcare environments (high overdose prevalence, suboptimal emergency response systems). Over half of participants had recent experience administering intervention-provided naloxone. Experiences administering naloxone to peers was largely shaped by social environment considerations (anticipated negative reaction from recipients attributable to physiological withdrawal, loss of high, and economic loss). Participants who felt strong social ties to their community often administered naloxone despite anticipated consequences.While there is a growing body of research on naloxone experiences [