Table 3.

Responder Barriers to Naloxone Use and Acceptance

Subtheme	Illustrative Quote
Belief that naloxone enables opioid use
Increased opioid use	Why is because I think it does the same thing as, “Hey, listen… You can go to Walgreens and you can get free Narcan. As long as you have that, listen, listen, listen. As long as you and I are going to shoot up together, I got this free Narcan, so if I go out you got to just jam this in my arm, and we’re good to go. I can shoot all the heroin I want because I got Narcan.” [police]
Enables riskier use of opioids	People are getting Narcan more often and I think knowing that it’s out there… Whether they are choosing to be riskier and take higher doses… I think we’re seeing more people who have had repeat Narcan administrations. [emergency department]
Naloxone does not address underlying addiction	Narcan has been billed as a miracle drug by politicians, and bureaucrats, and so-called experts. When the timing is right, it is a miracle drug. However, it doesn’t help everybody, and it will do nothing or you in the long term. It is a short-term fix, unfortunately, for a very long-term problem. [emergency medical services]
Difficult patient encounters after naloxone	When you gave an IV, if you administered it too fast, people would wake up instantly. They would be incredibly violent and angry, so now you have an angry, combative patient and a contaminated sharp needle in the back of a very small ambulance, and that posed a huge risk for us. [emergency medical services]
Titration of naloxone	If we can get you to where you’re breathing well and oxygenating yourself, then that’s really how much Narcan you need. Again, if you have the time and the staffing to do it in that nuanced manner, you can give smaller doses to get that effect and not induce this acute withdrawal state… We didn’t like putting these guys into acute withdrawal because it was never pleasant for us or them. [emergency department]
Belief that lay use prevents people from going to the ED	I think the bad side is I don’t think we’re called as much now. I think they’re just using the Narcan and then just saying, “We don’t want the police or the EMS there.” [emergency medical services]