This week’s NDEWS Weekly Briefing focuses on naloxone/Narcan® access and overdose prevention, highlighting efforts to expand the availability of this lifesaving medication as communities continue to respond to the overdose crisis. Featured content includes an NDEWS Special Report examining naloxone-related trends and overdose response, as well as an NDEWS Rapid Street Reporting (RSR) Special Report that provides community-level insights into naloxone awareness, access, and use among people who use drugs and those most likely to witness an overdose.

This week's focus is further informed by a recent Psychology Today article by NDEWS Scientific Advisory Group member Mark Gold, M.D., which argues that naloxone/Narcan® should be as widely available as other emergency medical interventions. The article emphasizes making naloxone/Narcan® accessible in workplaces, schools, college campuses, public venues, transportation settings, and homes, while also stressing that overdose reversal is only the beginning of recovery and should be followed by timely connection to treatment and support services.

As communities continue to expand overdose prevention efforts, understanding where naloxone/Narcan® is available, how it is distributed, and how individuals are connected to care after an overdose remains important. 

As always, we welcome your input.

Click here for a PDF version of the report.

Click here to learn more about the NDEWS Special Reports.

Click here for a PDF version of the report.

Click here to learn more about the NDEWS Rapid Street Reports.

What is Naloxone/Narcan®? Naloxone (commonly recognized by the brand name Narcan®) is an opioid receptor antagonist central to public health overdose prevention that is available in intranasal spray, as an injectable, and in combination pharmaceutical formulations. It is designed to rapidly reverse opioid-induced central nervous system and respiratory depression by competitively displacing opioid agonists from receptor sites.

Why are we reporting on this? Continued online discussions reveal extensive community reliance on naloxone across diverse settings, alongside notable public health concerns regarding persistent pharmacological misconceptions, the physiological impact of acute opioid reversal, and emerging reports of illicit botanical or synthetic products requiring antagonist administration. Furthermore, discussions highlight ongoing interest in off-label regimens, such as micro-dosed antagonist protocols to manage opioid tolerance, as well as questions regarding tamper-resistant combination pharmaceuticals.

Previous NDEWS Web Monitoring Reports:
- 8/21/2026 - Naloxone
- 8/29/2025 - Naloxone

Public Health Impacts: Reddit discussants report acute physiological and psychological distress associated with precipitated withdrawal following naloxone administration, commonly citing rapid onset of gastrointestinal symptoms, motor restlessness, chills, and elevated anxiety. Commenters describe post-resuscitation physical soreness, respiratory complications such as pulmonary edema, and lingering emotional trauma following severe overdose events. Multiple discussants also report financial barriers related to retail pricing when attempting to purchase over-the-counter nasal spray formulations, leading to increased reliance on community distribution networks and mail-based risk reduction initiatives.

How is it Being Discussed? Reddit commenters frequently emphasize carrying naloxone as an essential risk reduction practice, actively sharing information about free distribution sources at community health clinics, festival rest stops, and mail-delivery programs. Discussants regularly recommend having naloxone accessible when consuming unregulated substances due to the risk of unintentional synthetic opioid exposure. Recent conversations also reference official public health notices regarding smoke-shop botanical and herbal products, such as kava and Cat's Claw preparations adulterated with concentrated or synthetic kratom alkaloids, in which naloxone administration is recommended for suspected overdoses. A notable portion of the discourse involves pharmacological misconceptions, with commenters frequently inquiring whether naloxone can reverse sedation or overdose caused by non-opioid substances such as benzodiazepines, alcohol, cocaine, or dissociatives. Community members also discuss protocols involving ultra low-dose antagonist preparations intended to prevent tolerance or physical dependence during chronic opioid administration. Additionally, discussants analyze prescription formulations combining naloxone with agonists such as tilidine, oxycodone, or buprenorphine, debating whether crushing or alternative routes of administration bypass abuse-deterrent mechanisms or inadvertently precipitate withdrawal.

Read more about NDEWS Web Monitoring Reports.

A recent article in Psychology Today by NDEWS Scientific Advisory Group member Mark Gold, highlighted the critical role of naloxone (Narcan®) in reducing opioid overdose deaths and expanding overdose response efforts beyond healthcare settings. Citing recent declines in US overdose mortality, the article notes that widespread naloxone distribution has contributed to saving lives and supports Occupational Safety and Health Administration's recommendation that employers make naloxone available in workplaces and train employees to recognize and respond to overdoses. The author emphasizes that while naloxone can reverse opioid overdoses and create opportunities for recovery, it is not a substitute for treatment, underscoring the need for timely linkage to evidence-based care following overdose reversal.

Read the full study here.

A recent publication in Substance Use: Research and Treatment by Horace et al. evaluated the impact of a risk reduction-focused training program for 861 first responders across Louisiana. The study found significant improvements in risk reduction attitudes following training, including greater acceptance of evidence-based risk reduction approaches, increased overdose response confidence, and reduced stigma toward individuals with substance use disorder. The authors conclude that risk reduction-focused training may be an effective strategy for improving first responder preparedness and supporting overdose response efforts.

Read the full study here.

A recent publication in Frontiers in Public Health by Rubi et al. described the implementation of mobile medical units across eight Ohio communities as part of the HEALing Communities Study to expand naloxone distribution and facilitate linkage to medications for opioid use disorder (MOUD). All mobile units provided overdose education and naloxone distribution, while most also connected individuals to treatment services, including same-day appointments, transportation assistance, and telehealth-supported care. The authors report that community partnerships, local leadership, and data-informed deployment strategies supported implementation, while stigma and community skepticism were common barriers.

Read the full study here.

A recent publication in JAMA Network Open by Eldridge et al. assessed same-day availability of over-the-counter naloxone across 1,108 US retail pharmacies following FDA approval of nonprescription naloxone. The study found that 61.4% of pharmacies reported same-day naloxone availability without a prescription, with naloxone most commonly located behind the pharmacy counter and an average cost of $52.07. Corporate chain pharmacies were more likely than independent, medical-affiliated, and food or mass-merchandiser pharmacies to offer same-day access, and pharmacies located in areas with higher proportions of White residents were more likely to have naloxone available. The authors conclude that naloxone availability and affordability remain uneven despite over-the-counter status, highlighting opportunities to improve access in underserved communities.

Read the full study here.

Christopher R. McCurdy, Ph.D., FAAPS, is a broadly trained medicinal chemist, behavioral pharmacologist and pharmacist whose research focuses on the design, synthesis and development of drugs to treat pain and drug abuse. The NDEWS Webinar presented by Dr. McCurdy discussed 7-hydroxymitragynine (7-OH) and other recently scheduled synthetic substances.

Watch the webinar here.

Are you committed to advancing the science of substance use and public health? The University of Florida’s NIDA-funded T32 Training Program offers predoctoral and postdoctoral scholars an exceptional opportunity to launch impactful research careers focused on NDEWS!

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- A collaborative, inclusive research community committed to reducing the burden of substance use

Eligibility:
- US citizens or permanent residents
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Location: Gainesville, Florida — a dynamic hub for scientific innovation with high quality of life and low cost of living.

The NDEWS Weekly Briefing curates emerging data and findings from across the Early Warning Network, which includes three core components: our Scientific Advisory Group (SAG), comprised of national experts and federal partners; our Sentinel Site Directors (SSDs), who lead local surveillance in key geographic regions; and our Community-Based Health Experts, who provide on-the-ground insights from populations most impacted by drug trends. Together, these contributors generate timely, multidisciplinary and impactful information, ranging from peer-reviewed research findings to local surveillance data. These contributions inform public health and research communities.

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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:

     • NDEWS Special Reports using substance-related EMS data
     • NDEWS Rapid Street Reporting (RSR) survey data reports
     • NDEWS Web Monitoring Team Reddit Alerts
     • NDEWS Sentinel Site Reports
     • Previous issues of the NDEWS Weekly Briefings

The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). 

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