Understanding disparities in access to naloxone among people who inject drugs in Southeast Michigan using respondent driven sampling

•We examined naloxone access of people who inject drugs (PWID) in Southeast Michigan.•Overall self-reported naloxone access was: 24.9 %.•PWID naloxone access by location were: 18.3 %, urban; 41.9 %, suburban/rural.•Naloxone access is associated with race/ethnicity, social economic status (e.g. insurance coverage) and recent homelessness.•No age or gender differences in naloxone access. Given the rising incidence of opioid overdose in the United States, naloxone access is critical for high-risk populations, such as persons who inject drugs (PWID). Yet not all PWID have access to this life-saving antidote. With PWID in Michigan recruited via respondent driven sampling in 2017, after the 2016 standing order expanding naloxone availability through local pharmacies, we explored possible access disparities. With 46 seeds recruited from agencies serving local PWID communities, we obtained a sample of N = 410 PWID from Southeast Michigan (n = 285 form urban Detroit, and 125 for suburban/rural areas outside Detroit). Participants completed questionnaires detailing socio-demographics, health history, substance use and treatment access, including naloxone. We used multiple logistic regression to examine the predictors of self-reported naloxone access based on participant characteristics (e.g., demographics, health status) and geography (urban vs. suburban/rural). Self-reported naloxone access differed significantly by location (urban = 18.3 %; suburban/rural = 41.9 %). In multivariable analyses, naloxone access was significantly associated with race, household income, employment, health insurance, recent homelessness, prescription opioid usage, Hepatitis A and C status, Hepatitis A vaccination, Hepatitis C testing, access to drug treatment and services, and hospital as the usual place of care. Despite recent policies to expand access, our results indicate that naloxone access among high-risk PWID is low. This warrants future research to identify effective channels to reduce barriers and increase naloxone access.