KNOWLEDGE OF, AND ACCESS TO NARCAN (NALOXONE) AMONG NEBRASKAN ADULTS: IN 2020, 2021, AND 2022.

KNOWLEDGE OF, AND ACCESS TO NARCAN (NALOXONE) AMONG
NEBRASKAN ADULTS: IN 2020, 2021, AND 2022.
Patrick Habecker, Nova Gocchi Carrasco, Rick Bevins
1-23
EXECUTIVE SUMMARY
In the United States there were 102,429 deaths from
overdoses in the 12 months ending July, 2022. Of those
deaths, about 75% involved an opioid of some form. A
primary tool to prevent overdose deaths that involve opioids
is the distribution of naloxone and Narcan (a patented nasal
spray of naloxone). Naloxone is an opioid antagonist that
can reverse opioid overdoses and in its Narcan form, is easy
to administer by those with no medical training.
Narcan is a behind-the-counter substance at pharmacies
which can restrict access to those without a prescription.
However, in 2015 the state of Nebraska passed a law to
make access to naloxone and Narcan easier. A key part is a
standing order that allows those without a prescription to
purchase Narcan from any pharmacy in the state. The state
has also created a free Narcan distribution program that is
currently available at 94 pharmacies across Nebraska.
Ideally these measures should make Narcan accessible to
any Nebraskan. In 2020 the RDAR center added a series of
questions to the Nebraska Annual Social Indicators Survey
(NASIS) to assess how many Nebraskans knew what Narcan
and naloxone are, if they knew where to obtain it, and if they
knew how to use Narcan. We asked the same set of questions
in 2021 and in 2022.
The first question asked participants, “Do you know where
to get Narcan (naloxone) if you needed it?” and participants
could respond: “Yes,” “No,” or “I don’t know what this is.”
In all three years of the survey we estimate that a quarter
to a third of adult Nebraskans do not know what Narcan
(naloxone) is at all. In 2020, 31.8% [29.1%-34.7%]; in 2021,
33.2% [30.3%-36.3%]; and in 2022, 24.5% [21.5%-27.9%].
In all three years, we estimate that only 10-20% of adult
Nebraskans know where to get Narcan (naloxone). In 2020,
14.6% [12.7%-16.9%]; in 2021, 17.7% [15.2%-20.4%]; and in
2022, 18.4% [15.6%-21.6%].
Participants who knew what Narcan was were also asked if
they knew how to use Narcan. We estimate that only about
a quarter of Nebraskans who know what Narcan is, report
knowing how to use it. In 2020, only 22.5% [19.7%-25.7%]
responded “Yes.” In 2021, our estimate is 22.9% [19.6%-
26.6%] and in 2022 our estimate is 22.8% [19.2%-26.8%] of
adult Nebraskans know how to use Narcan.
We also asked participants if they knew anyone who has
experienced a drug overdose in the past year. In 2020, 7.6%
[6.1%, 9.4%] of adult Nebraskans said they did. In 2021, 6.6%
[5.2%, 8.5%] and in 2022 we estimate that 6.0% [4.4%, 8.3%]
of Nebraskan adults knew someone who had experienced a
drug overdose in the past year. An important note is that our
question allows for participants to be thinking of people they
may know either in or outside of Nebraska who experienced
a drug overdose.
We also estimate these outcomes for different regions within
Nebraska. Estimates are produced for each of the behavioral
health regions within the state, and for Omaha and Lincoln
separately.
METHODS
The Nebraska Annual Social Indicators Survey (NASIS) is
a yearly survey conducted by the Bureau of Sociological
Research at the University of Nebraska-Lincoln. The survey
uses a stratified random address-based sample of Nebraskan
households. Sampling strata are defined by the six behavioral
health regions in Nebraska. Regions 5 and 6 are further
split to create a sampling stratum for Lincoln alone within
Region 5, and another for Omaha alone within Region 6.
Within each of the 8 strata, 1,000 addresses were randomly
selected, providing a sample frame of 8,000 addresses each
year of the survey.
Surveys are then mailed to each address and one Nebraskan
who is at least 19 or older is asked to complete the survey.
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In 2021 and 2022, randomly selected households were
offered the chance to complete the survey online instead of
completing a paper form. Surveys were fielded from August
to November in 2020, from August to November in 2021,
and from July to November in 2022.
The response rates for the NASIS surveys were 27.7% in
2020, 21.1% in 2021, and 18.2% in 2022. Response rates
are calculated using the AAPOR standard definition for
Response Rate 2.
Survey weights for within household probability of selection,
nonresponse, region, age, and sex are used for each year of
data collection. All estimates in this report were produced
with Stata 15 using the svy command suite to account for
weights and stratified sampling design.
Complete methodological reports for the sampling, survey
procedures, and weight creation are available here.
MEASURES
The first question asked participants, “Do you know where
to get Narcan (naloxone) if you needed it?” and participants
could respond: “Yes,” “No,” or “I don’t know what this is.”
The second question asked participants, “Do you know how
to use Narcan (naloxone)?” and participants could respond
“Yes” or “No.” This question was only asked to participants
who had answered Yes or No to the first question.
The third question asked participants, “Do you know anyone
who has experienced a drug overdose in the past year?”
and participants could respond “Yes” or “No.”
Within-State Estimates
We estimate the percent of adult Nebraskans who answered
our questions in eight separate regions within Nebraska.
These regions are based on the six behavioral health regions
of Nebraska and are defined by county borders. Region 5
and 6 include the two largest cities in the state, Lincoln and
Omaha respectively. To compare cities directly, we estimate
results for Lincoln by itself (defined by ZIP codes) and for
Region 5 without including Lincoln. We do the same for
Omaha and Region 6. This gives us eight, mutually exclusive
regions within Nebraska.
Figure 1 shows the estimated percent of adult Nebraskans
who said they don’t know what Narcan (naloxone) is when
asked if they knew where to get Narcan (naloxone) in 2020,
2021, and 2022. In most areas of the state we estimate lower
percent of adults responding this way in 2022 than in
prior years. Omaha is the lowest estimate at 15.4% [10.3%,
22.4%] followed by Lincoln at 21.2% [14.4%, 30.0%]. Region
4 seems to consistently be an area with the highest estimated
percentage of adults who do not know what Narcan (naloxone)
is. Some caution is warranted with these comparisons,
given that that confidence intervals are quite wide.
Figure 2 shows the estimated percent of adult Nebraskans
who said “Yes” when asked if they know where to get Narcan
(naloxone) if they needed it. The estimates for Region 1, 2,
3, Lincoln, 6, and Omaha are all between 18% and 21% in
2022. Region 4 and Region 5 outside of Lincoln, are both areas
with lower estimates in 2022. Some caution is warranted
with these comparisons, given that that confidence intervals
are quite wide.
Figure 3 shows the estimated percent of adult Nebraskans
who said “No” when asked if they know where to get Narcan
(naloxone) if they needed it. This is the most typical response
in almost every region across all three years. In 2022,
we estimate that 66.7% [57.5%, 74.7%] of adults in Omaha
would say this, and 58.3% [48.9%, 67.2%] in Lincoln. Other
regions are also quite high, ranging between 48% and 55%.
Where there appears to be an increase in the percentage of
people saying “No” in a region, this is typically due to fewer
people saying “I don’t know what this is” in that area. So
more people know what Narcan (naloxone) is, but there
are not necessarily increases in knowing how to get Narcan
(naloxone).
Figure 4 shows the estimated percent of adult Nebraskans
who said “Yes” they know how to use Narcan (naloxone).
The highest estimates in 2022 are in Omaha (31.3% [22.21%,
42.2%]) and in Region 1 (30.2% [19.8%, 43.1%]. Regions 3,
4, 5 without Lincoln, Lincoln, and Region 6 without Omaha
have estimates that range between 18% and 23%. Region
2 has the lowest estimate in 2022 at 14.7% [9.1%, 22.8%].
Many regions show a possible decrease in the percent of
participants saying yes over time. However, this may be a
result of a higher proportion of adults in Nebraska knowing
what Narcan (naloxone) is – a requirement to be asked this
question – without a corresponding increase in knowledge
of how to use Narcan (naloxone).
Figure 5 shows the estimated percent of adult Nebraskans
who said “Yes” they knew someone who had experienced
a drug overdose in the past year. In 2022, across all regions
our estimates range between four and eight percent. There
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are slightly higher estimates in Region 1, 4, 5 without Lincoln,
and in Lincoln. Some caution is warranted with these
comparisons, given that the estimates are quite close to each
other.
SUMMARY
Knowledge of what Narcan is, how to get it, and how to use
it, remains fairly low across the state of Nebraska. There do
seem to be more people who are aware of what Narcan is
over time, but this does not appear to be translating into
higher levels of knowing how to get Narcan, or how to use it.
FIGURES
In all figures Regions are abbreviated by R and their region number. For example, results for Region 1 are shown as
R1. Region 5 and Region 6 are special cases as their estimates are calculated for the territory that does not include
their major cities (Lincoln and Omaha). Instead, estimates for Lincoln and Omaha are calculated separately.
Figure 1 - Q: “Do you know where to get Narcan (naloxone) if you needed it? ” A: “Yes,” “No,” “I don’t know what
this is.” Estimated percent saying “I don’t know what this is” and 95% confidence intervals in [brackets].
Nebraska Overall: 2020, 31.8% [29.1%, 34.7%]; 2021, 33.2% [30.3%, 36.3%]; 2022, 24.5% [21.5%, 27.9%]
R4
2020: 35.4% [28.7%, 42.8%]
2021: 46.0% [38.1%, 54.1%]
2022: 35.8% [27.3%, 45.5%]
R6 – No Omaha
2020: 33.7% [27.5%, 40.5%]
2021: 34.4% [27.7%, 41.8%]
2022: 27.3% [20.5%, 35.3%]
R1
2020: 33.7% [26.9%, 41.3%]
2021: 45.7% [36.7%, 55.1%]
2022: 30.1% [21.5%, 40.4%]
R6 – Omaha Only
2020: 29.0% [22.7%, 36.1%]
2021: 32.9% [25.6%, 41.1%]
2022: 15.4% [10.3%, 22.4%]
R2
2020: 33.1% [25.9%, 41.1%]
2021: 43.5% [35.6%. 51.8%]
2022: 27.6% [19.9%, 37.0%]
R3
2020: 34.5% [28.3%, 41.3%]
2021: 40.9% [33.4%, 48.9%]
2022: 30.2% [22.6%, 39.0%]
R5 – No Lincoln
2020: 35.9% [29.0%, 43.4%]
2021: 35.4% [28.1%, 43.4%]
2022: 29.6% [21.7%, 38.9%]
R5 – Lincoln Only
2020: 28.5% [22.5%, 35.4%]
2021: 23.3% [17.6%, 30.1%]
2022: 21.2% [14.4%, 30.0%]
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Figure 2 - Q: “Do you know where to get Narcan (naloxone) if you needed it? ” A: “Yes,” “No,” “I don’t know what
this is.” Estimated percent saying “Yes” and 95% confidence intervals in [brackets].
Nebraska Overall: 2020, 14.6% [12.7%, 16.9%]; 2021, 17.7% [15.2%, 20.4%]; 2022, 18.4% [15.6%, 21.6%]
R4
2020: 17.9% [12.5%, 25.0%]
2021: 13.9% [9.0%, 20.9%]
2022: 14.7% [9.4%, 22.1%]
R6 – No Omaha
2020: 12.4% [8.6%, 17.7%]
2021: 15.7% [10.9%, 22.0%]
2022: 18.2% [12.5%, 25.8%]
R1
2020: 8.1% [4.8%, 13.4%]
2021: 15.9% [10.0%, 24.3%]
2022: 21.3% [13.8%, 31.4%]
R6 – Omaha Only
2020: 12.7% [8.7%, 18.1%]
2021: 12.0% [7.6%, 18.4%]
2022: 18.0% [11.7%, 26.6%]
R2
2020: 13.9% [9.0%, 20.7%]
2021: 15.1% [9.9%, 22.4%]
2022: 21.1% [14.5%, 29.7%]
R3
2020: 13.5% [9.2%, 19.4%]
2021: 10.0% [6.2%, 15.9%]
2022: 18.6% [12.3%, 27.1%]
R5 – No Lincoln
2020: 17.5% [12.6%, 23.8%]
2021: 20.3% [14.5%, 27.5%]
2022: 15.8% [10.2%, 23.6%]
R5 – Lincoln Only
2020: 15.7% [11.3%, 21.4%]
2021: 25.0% [19.0%, 32.1%]
2022: 20.5% [14.1%, 28.9%]
Figure 3 - Q: “Do you know where to get Narcan (naloxone) if you needed it? ” A: “Yes,” “No,” “I don’t know what
this is.” Estimated percent saying “No” and 95% confidence intervals in [brackets].
Nebraska Overall: 2020, 53.5% [50.5%, 56.5%]; 2021, 49.1% [45.8%, 52.4%]; 2022, 57.0% [53.2%, 60.8%]
R4
2020: 46.7% [39.3%, 54.2%]
2021: 40.1% [32.5%, 48.1%]
2022: 49.5% [40.4%, 58.7%]
R6 – No Omaha
2020: 53.9% [47.1%, 60.5%]
2021: 49.9% [42.5%, 57.3%]
2022: 54.5% [46.1%, 62.7%]
R1
2020: 8.1% [4.8%, 13.4%]
2021: 15.9% [10.0%, 24.3%]
2022: 21.3% [13.8%, 31.4%]
R6 – Omaha Only
2020: 58.4% [51.0%, 65.4%]
2021: 55.1% [46.8%, 63.2%]
2022: 66.7% [57.5%, 74.7%]
R2
2020: 13.9% [9.0%, 20.7%]
2021: 15.1% [9.9%, 22.4%]
2022: 21.1% [14.5%, 29.7%]
R3
2020: 13.5% [9.2%, 19.4%]
2021: 10.0% [6.2%, 15.9%]
2022: 18.6% [12.3%, 27.1%]
R5 – No Lincoln
2020: 17.5% [12.6%, 23.8%]
2021: 20.3% [14.5%, 27.5%]
2022: 15.8% [10.2%, 23.6%]
R5 – Lincoln Only
2020: 15.7% [11.3%, 21.4%]
2021: 25.0% [19.0%, 32.1%]
2022: 20.5% [14.1%, 28.9%]
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Figure 4 - Q: “Do you know how to use Narcan (naloxone)?” A: “Yes” or “No.”
Estimated Proportion Saying “Yes” and 95% confidence intervals in [brackets].
Nebraska Overall: 2020, 22.5% [19.7%, 25.7%]; 2021, 22.9% [19.6%, 26.6%]; 2022, 22.8% [19.2%, 26.8%]
R4
2020: 32.2% [23.7%, 41.9%]
2021: 21.4% [13.4%, 32.4%]
2022: 19.1% [11.9%, 29.2%]
R6 – No Omaha
2020: 23.6% [17.5%, 31.1%]
2021: 24.2% [17.4%, 32.7%]
2022: 23.5% [16.2%, 32.8%]
R1
2020: 12.5% [7.4%, 20.3%]
2021: 17.1% [9.5%, 28.7%]
2022: 30.2% [19.8%, 43.1%]
R6 – Omaha Only
2020: 29.0% [22.7%, 36.1%]
2021: 32.9% [25.6%, 41.1%]
2022: 15.4% [10.3%, 22.4%]
R2
2020: 15.1% [9.4%, 23.3%]
2021: 26.0% [16.6%, 38.4%]
2022: 14.7% [9.1%, 22.8%]
R3
2020: 23.9% [16.9%, 32.5%]
2021: 23.1% [15.6%, 32.8%]
2022: 18.8% [11.6%, 29.0%]
R5 – No Lincoln
2020: 23.9% [16.8%, 32.9%]
2021: 25.8% [17.8%, 35.7%]
2022: 18.1% [10.9%, 28.5%]
R5 – Lincoln Only
2020: 16.8% [11.7%, 23.5%]
2021: 21.8% [15.4%, 30.0%]
2022: 20.7% [13.6%, 30.2%]
Figure 5 - Q: “Do you know anyone who has experienced a drug overdose in the past year?” A: “Yes” or “No.”
Estimated Proportion Saying “Yes” and 95% confidence intervals in [brackets].
Nebraska Overall: 2020, 7.6% [6.1%, 9.4%]; 2021, 6.6% [5.2%, 8.5%]; 2022, 6.0% [4.4%, 8.3%]
R4
2020: 7.1% [4.1%, 12.3%]
2021: 4.9% [2.3%, 10.2%]
2022: 6.8% [3.4%, 13.0%]
R6 – No Omaha
2020: 7.7% [4.6%, 12.6%]
2021: 9.0% [5.5%, 14.4%]
2022: 4.9% [2.3%, 9.9%]
R1
2020: 4.9% [2.6%, 9.0%]
2021: 5.9% [2.8%, 12.0%]
2022: 6.6% [3.2%, 12.8%]
R6 – Omaha Only
2020: 7.9% [4.9%, 12.6%]
2021: 3.6% [1.5%, 8.3%]
2022: 5.0% [1.8%, 13.0%]
R2
2020: 9.8% [5.8%, 16.0%]
2021: 12.5% [7.8%, 19.6%]
2022: 4.7% [2.3%, 9.5%]
R3
2020: 5.3% [3.0%, 9.2%]
2021: 7.6% [4.3%, 12.9%]
2022: 4.4% [2.0%, 9.2%]
R5 – No Lincoln
2020: 4.8% [2.5%, 8.8%]
2021: 6.1% [3.1%, 11.4%]
2022: 7.7% [3.8%, 14.7%]
R5 – Lincoln Only
2020: 10.0% [6.4%, 15.3%]
2021: 7.6% [4.3%, 12.9%]
2022: 6.8% [3.5%, 13.0%]
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CONTACT
Patrick Habecker, Research Assistant Professor
Co-Director, Longitudinal Networks Core
Rural Drug Addiction Research Center
Email: phabecker2@unl.edu
Website: rdar.unl.edu
This work is supported by the National Institute of General Medical Sciences of the National Institutes of Health
[P20GM130461] and the Rural Drug Addiction Research Center at the University of Nebraska-Lincoln. The content is solely
the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or
the University of Nebraska.
The University of Nebraska does not discriminate based on race, color, ethnicity, national origin, sex, pregnancy, sexual
orientation, gender identity, religion, disability, age, genetic information, veteran status, marital status, and/or political
affiliation in its programs, activities, or employment.
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