Corresponding Author

Victor Garcia


Author Affiliations

1. Victor Garcia, PhD: Senior Research Scientist, Prevention Research Center, Pacific Institute of Research and Evaluation (Berkeley CA); E-mail: vgarcia@PREV.org

2. Lisa McCann, MA: Graduate Research Assistant, Indiana University of Pennsylvania (IUP) (Indiana PA)

3. Eric Lauber, PhD: Professor of Communications Media, College of Education and Communications, IUP

4. Christian Vaccaro, PhD, MS, MA: Professor of Sociology, Sociology Department, College of Health and Human Services, IUP

5. Melissa Swauger, PhD, MA: Professor, Department of Nonprofit Management, Empowerment, and Diversity Studies, Slippery Rock University of Pennsylvania (SRU) (Slippery Rock PA)

6. Alex Daniel Heckert, PhD, MA: Professor and former Chair, Sociology Department, College of Health and Human Services, IUP

Author Area of Expertise

Victor Garcia, area of expertise: substance abuse disorders (SUDs) among Latinx migrants and immigrants, SUD interventions and treatments, qualitative research

Lisa McCann, area of expertise: SUDs among the rural poor in Western Pennsylvania

Erick Lauber, area of expertise: Leadership training, media and communication, and SUDs in Western Pennsylvania

Christian Vaccaro, area of expertise: SUDs, violence, masculinity, families, and mixed methods research

Melissa Swauger, area of expertise: SUDs, gender and families, nonprofits, and mixed methods research

Alex Daniel Heckert, area of expertise, SUDs, social learning theory, and survey methods


Introduction: Take-home naloxone (THN) is being made available across rural Appalachia to curb opioid overdose fatalities. Despite this initiative, some opioid users do not possess naloxone, and if they do, do not administer it to others.

Purpose: Research findings on risk factors that contribute to opioid overdose are presented. These factors, identified in a sample of 16 overdose cases, are (1) early onset age of opioid use; (2) progressive opioid use; (3) a transition from pain medication to heroin and fentanyl; (4) fears of being arrested at a naloxone intervention if first responders are contacted, and (5) limited knowledge of Good Samaritan Laws.

Methods: The findings are based on a subsample 16 overdose victims who were identified during a one-year (2018) qualitative study on the decline of overdose fatalities in four rural counties in Western Pennsylvania. They were recruited from a larger sample of 50 current and former substance users and were interviewed a second time using a semi-structured interview guide about their overdose experiences. All interview data were analyzed using thematic analysis via NVivo.

Results: Findings reveal that risk factors contribute to a severe opioid dependence that interferes with naloxone use. These factors also hinder adherence to proper naloxone protocol, designed to place overdose victims in contact with treatment providers.

Implications: Recommendations are made for additional research and for pursuing measures to increase efficacy of naloxone interventions. They include developing naloxone campaigns aimed at high-risk individuals, improving their knowledge of Good Samaritan Laws, increasing adherence to THN protocols that improve the possibility of treatment, and using community harm reduction specialists for community outreach.



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Garcia V, McCann L, Lauber E, Vaccaro C, Swauger M, Heckert AD. High-risk individuals and naloxone use: Implications for THN programs in rural Appalachian communities. J Appalach Health 2023;5(3):9–21. DOI: https://doi.org/10.13023/jah.0503.02