ABSTRACT Improving naloxone access is a central pillar of the policy landscape to curb rising overdose deaths rates in the United States. In particular, improving access among “laypersons” is considered one of the most cost-effective naloxone distribution options, but there is surprisingly little evidence about the share of people who carry naloxone, where and how those who carry naloxone obtained the medication, barriers and perceived barriers to purchasing or otherwise obtaining naloxone, optimal price points, and so on. Although two over-the-counter (OTC) naloxone products were recently approved, there is little research about how this policy decision will change behavior. This project will provide some of the first evidence on the state of naloxone carrying in the United States, including near real-time monitoring of knowledge of and purchase behavior related to the OTC products as they become more widely available. This project will also track new and evolving barriers to the purchasing of OTC naloxone. We will use vignettes to study optimal price points for naloxone at the pharmacy and, separately, for the OTC naloxone products, providing especially timely evidence as policymakers wrestle with how to keep the OTC products affordable when many sources of insurance may not cover them. We will field a survey in each year of the project about naloxone access and use in (1) a nationally- representative online sample and (2) a sample of individuals self-reporting “opioid dependence.” These samples provide an opportunity to gather and publish timely evidence as the naloxone market experiences a major shift, potentially encountering new and unforeseen barriers further hindering access and use of naloxone. This project will ask specifically about barriers such as stigma, price, and other factors to understand the scope for improving naloxone purchasing and possession. We will report time-sensitive evidence about the importance of several factors with policy recommendations to address those barriers. Given policymakers’ specific concerns with price, we will field vignettes to determine the willingness-to-pay distribution for naloxone (both at the pharmacy and OTC). We will report how naloxone purchasing would change if prices were reduced to different levels. As overdose death rates continue to rise to unprecedented levels in the United States, improving naloxone access has become an increasingly necessary policy objective. Yet, we do not have access to even basic metrics to understand how naloxone carrying rates are evolving. This project will represent a major step forward in our goal to increase naloxone use.

PROJECT NARRATIVE Despite the importance of improving naloxone access among laypersons, we have surprisingly limited information about the share of people who carry naloxone, where and how those who carry naloxone obtained the medication, barriers and perceived barriers to purchasing or otherwise obtaining naloxone, optimal price points, and so on. We will field two national surveys to gather this information with particular emphasis on tracking the impacts of the new over-the-counter naloxone products to provide time-sensitive evidence. We will focus specifically on new barriers to access as these products become more widely available and on understanding the possible role of prices in hindering additional naloxone use.