Conclusion
anger, overdose
EVENT
Factors that influence rural PWUDs’ decisions to accept, carry, and administer naloxone are complex and touch upon all domains of their rural risk environment. Our sample included participants who had never heard of naloxone or had gaps in their understanding of its effectiveness and/or how to administer it. The C2H intervention altered participants’ healthcare environment by providing education on naloxone’s existence, effectiveness, and administration technique. Participants’ trust in REHNs (driven by REHNs’ knowledge of the community and non-stigmatizing approach) allowed participants to be receptive to new information about naloxone. Participants’ physical environments, characterized by slow emergency response systems, high prevalence of overdose, and presence of fentanyl drive decisions to carry naloxone despite anticipated and realized consequences (e.g., police harassment). Participants’ decisions to administer naloxone are sometimes complicated by social environment considerations. When PWUD administer naloxone to a network member, they are often acting against the recipient’s communicated desires and are sometimes met with anger. Although many rural PWUD administer naloxone despite social consequences, participants report that the event can be emotionally difficult, necessitating multipronged means of support.Findings highlight need for more community-centered OEND interventions; greater outreach to rural PWUD on local policy that impacts them; tailored strategies to help PWUD engage in productive dialogue with peers about naloxone and navigate interpersonal conflict associated with overdose reversal; and opportunities for rural PWUD to formally participate in emergency response systems as peer overdose responders.