Bystander preference for naloxone products: a field experiment

Katherine Marks, Douglas Oyler, Justin C. Strickland, Jody Jaggers, Monica F. Roberts, Dustin K. Miracle, Chase Barnes, Feitong Lei, Amanda Smith, Eric Mackin, Martika C. Martin, Patricia R. Freeman

Research output: Contribution to journalArticlepeer-review


Background: Bystander administration of naloxone is a critical strategy to mitigate opioid overdose mortality. To ensure bystanders’ willingness to carry and administer naloxone in response to a suspected overdose, it is critical to select products for community distribution with the highest likelihood of being utilized. This study examines bystanders’ preference for and willingness to administer three naloxone products approved by the FDA for bystander use and identify product features driving preference. Methods: The population was a convenience sample of individuals who attended the Kentucky State Fair, August 18–28, 2022, in Louisville, Kentucky. Participants (n = 503) watched a standardized overdose education and naloxone training video, rated their willingness to administer each of three products (i.e., higher-dose nasal spray, lower-dose nasal spray, intramuscular injection), selected a product to take home, and rated factors affecting choice. Results: After training, 44.4% chose the higher-dose nasal spray, 30.1% chose the intramuscular injection, and 25.5% chose the lower-dose nasal spray. Factors most influencing choice on a 10-point Likert scale were ease of use (9 [7–10]), naloxone dose (8 [5–10]), and product familiarity (5 [5–9]). Conclusions: Bystanders expressed high willingness to administer all studied formulations of naloxone products. Product choice preference varied as a function of product features. As the number and variety of available products continue to increase, continuous evaluation of formulation acceptability, in addition to including individuals with lived experience who are receiving and administering overdose reversal agents, is critical to support adoption and save lives.

Original languageEnglish
Article number171
JournalHarm Reduction Journal
Issue number1
StatePublished - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s).


  • Bystander overdose response
  • Naloxone distribution
  • Opioid reversal agents
  • Overdose education

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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