Community-administered naloxone for overdose reversal: The role of sex worker-led programming and occupational violence in a community-based cohort (2018–2024)

Over 5.5 years, over half of participants administered THN, which was associated with exposure to sex work-specific programs and occupational violence. Violence from clients, community members, and police independently increased the likelihood of THN administration. Findings suggest that marginalized sex workers, particularly those who use drugs in occupational settings, are uniquely positioned to respond to overdoses. This supports the feasibility of implementing sex worker-specific overdose interventions and highlights the need to expand community-based, sex worker-led safety, violence prevention, and care interventions to strengthen overdose prevention efforts and improve naloxone cascade metrics.