Table 2 Key themes and supporting quotations

Subset of participants with high levels of knowledge about naloxone access and high engagement with community harm reduction resources

Awareness about multiple sources for naloxone access

"You could go to the emergency room, a pharmacy or needle exchange." (Participant 12)

Engagement with community harm reduction resources

"They had the program started up where they were giving me… the Narcan and they was giving me different things, the free needles, the alcohol swabs and stuff like that. I would disperse it through the neighborhood. I was around some people that were greedy so, whenever they would go to get high, I would follow them to see if they were going to OD and I would Narcan them. I only Narcaned one person and I had someone Narcan me once." (Participant 5)

High levels of confidence about naloxone access and use

"[Community organization] always make sure you’re telling us something about something. So we never go there and don’t know anything. They’re always helping us, keeping us on point. I think it’s just a little overkill at this point. People should know already, why you need [naloxone] and the severity of it." (Participant 1)

Subset of participants with familiarity with naloxone but limited engagement with community harm reduction organizations and resources

Healthcare encounters were primary source of naloxone

“I’m on Suboxone in a small program and every time I get a small [prescription] of Suboxone, they give me a box of Narcan.” (Participant 16)

Familiar with naloxone through friends or social networks

“I was given Narcan before, just through friends, people I knew who gave it to me, but that was the first time me getting prescribed it through the emergency room” (Participant 6)

Dealers as a source for naloxone

“Ordinarily, if I go buy first it’s the heroin. I’ll then ask who has a little shot of [naloxone]. Sometimes they have it or they will give me the resources to go get it. Some people actually are selling it out there” (Participant 9)

Subset of participants with limited knowledge about overdose risk, overdose prevention, and naloxone access prior to ED encounter

Low awareness of overdose risk

“I never went looking for [naloxone] because I never thought I needed it” (Participant 17)

Limited knowledge about insurance coverage

“I never got [naloxone] because I didn’t know if my insurance paid for it or not” (Participant 13)

Lack of knowledge about naloxone and its role in reducing overdose risk

“People don’t know that [naloxone] exists until a doctor tells you about it. There’s nothing to find, or nothing around promoting it or anything. It’s just like a secret between the ER and different persons from the ER” (Participant 19)

Positive sentiments toward receiving naloxone in the ED

“I feel they were looking out for my best interest. They gave it to me just in case.” (Participant 2)

Naloxone as overdose prevention strategy

I don’t think that I’m somebody who is at risk for overdose … but ultimately, I understand the purpose of prescribing it to somebody, anybody who’s been under so much, who had so much medication” (Participant 4)

Sense of empowerment

“I thought [the naloxone prescription] was helpful. Now I can change someone’s life if I needed to.” (Participant 13)

Potential to feel stigmatized

“I felt insulted because I was like ‘Damn, what do I need Narcan for?’” (Participant 23)

Lack of communication about naloxone prescription

“I did not know that they were going to prescribe [naloxone] to me. They never said anything about it. I just found out, I think, when I looked at my discharge papers” (Participant 4)

“I was in the ED because of some other issues that I have with chronic pain and I found out. Well, I didn’t actually know that they were giving me Narcan or a prescription for Narcan until I got my list of prescriptions at discharge. So, I didn’t really know about it” (Participant 24)

Lack of communication about overdose risk

“I told them I was going through withdrawal and they, but nonetheless, they gave me a box of [naloxone]” (Participant 16)

“Well, say if you go in there for a different reason for what I went, I understand about it, because I’ve been on fentanyl. Other people might not be able to understand it and might take it as a harsh gesture” (Participant 19)