Take-home naloxone possession among people who inject drugs in rural West Virginia

•Nearly half of people who inject drugs (PWID) had received take-home naloxone.•PWID at high risk for overdose were more likely to have received naloxone.•THN possession was associated with believing doctors judge people who use drugs. Take-home naloxone (THN) possession among people who inject drugs (PWID) in rural communities is understudied. Better understanding the nature of THN possession among rural PWID could inform the implementation of overdose prevention initiatives. The purpose of this research is to determine factors associated with rural PWID having recently received THN. Data from a PWID population estimation study implemented in Cabell County, West Virginia were used for this research. Multivariable Poisson regression with a robust variance estimator was used to evaluate the independent effects of several measures (e.g., sociodemographics, structural vulnerabilities, substance use) on PWID having received THN in the past 6 months. Forty-eight percent of our sample (n = 371) of PWID reported having received THN in the past 6 months. Factors associated with having received THN were: age (adjusted Prevalence Ratio [aPR] = 1.02; 95% Confidence Interval [CI]: 1.01–1.03), having recently accessed sterile syringes at a needle exchange program (aPR = 1.82; 95% CI: 1.35–2.46), believing that doctors judge people who use drugs (aPR = 1.50; 95% CI: 1.07–2.12), and having witnessed at least one non-fatal overdose in the past 6 months (aPR = 1.44; 95% CI: 1.06–1.94). Greater numbers of overdose events in the past 6 months were also associated with having received THN. Among rural PWID in West Virginia, slightly less than half received THN in the past 6 months. Rural communities need overdose prevention interventions that are responsive to the unique needs of rural PWID, decrease stigma, and ensure PWID have access to harm reduction services and drug treatment programs.