Predictors of Naloxone Carriage Among People Who Use Opioids in Maine

BACKGROUND: Despite expanded naloxone distribution efforts, many people who use opioids (PWUO) do not carry naloxone. Limited research examines how knowledge of Good Samaritan Laws (GSLs), trust in law enforcement to uphold these protections, and opioid use patterns impact naloxone carriage, particularly in rural contexts. This study addresses these gaps by assessing predictors of carriage in a rural U.S. setting. METHODS: This cross-sectional study analyzes survey data from a non-probability sample of 153 PWUO in Maine recruited through community outreach. Ordinary least squares regression models identify predictors of naloxone carriage during opioid use (Model 1) and in general (Model 2). RESULTS: Across both models, more frequent opioid use and a history of overdose are associated with greater naloxone carriage. In Model 1, lower trust in law enforcement to uphold GSL protections is suggestively associated with higher carriage. In Model 2, higher perceived overdose risk and non-White race are associated with lower naloxone carriage. CONCLUSIONS: Findings highlight variation in naloxone carriage across behavioral, perceptual, and structural factors. Expanding naloxone outreach and education, normalizing carriage, strengthening post-overdose interventions, and addressing structural barriers may improve carriage among high-risk populations, particularly in rural settings.