Perceived Stigma Toward Naloxone Among Overdose Education and Naloxone Distribution Program Participants: Implications for Opioid Overdose Response

Overdose education and naloxone distribution programs, also known as naloxone trainings, are a key strategy to reduce overdose fatalities. However, stigma is a documented barrier to successful program implementation, affecting training availability and participation. This study examines the relationship between perceived stigma toward naloxone and naloxone training outcomes among training attendees. Adults who attended a naloxone training in Michigan (N = 451) self-administered a web-based survey (February 2021-March 2022). A moderated mediation model was used to assess the relationship among perceived stigma toward naloxone, knowledge of opioid overdose management, and attitudes toward opioid overdose response, and the moderating effects of substance use history and racial-ethnic identity. In the moderated mediation model, greater perceived stigma toward naloxone (B = -.275, p = .045) and Black race (B = -6.093, p = .001) were associated with lower levels of knowledge. Greater knowledge was associated with more positive attitudes (B = .159, p < .001), and greater stigma was associated with less positive attitudes (B = -.570, p < .001). The indirect effect of stigma on attitudes through knowledge was significant for White participants only (bootstrapped CI [-.088, -.005]). For White participants, greater stigma was associated with lower levels of knowledge (B = -.275, p = .045). Findings suggest stigma may operate differently among White and Black naloxone training attendees. While health communication campaigns may help improve opioid overdose knowledge and attitudes among White individuals, structural interventions may be necessary to address perceived stigma toward naloxone among Black individuals.