Preparing Community Members to Respond to an Opioid Overdose

Funding: The research was supported by funds from the Florida A&M University Faculty Research Awards Program.

Abstract

This research aimed to improve community readiness to respond to opioid overdoses through pharmacist‑ and pharmacy learner–led naloxone (Narcan; Emergent BioSolutions) training in medically underserved areas. Participants completed pre‑ and posttraining surveys assessing their knowledge and confidence regarding opioid overdose recognition and naloxone use. Forty individuals completed the presurvey, and 38 completed the postsurvey. Posttraining results demonstrated substantial improvement, with agreement on knowledge and confidence items increasing from approximately 45% to 97%. Participants showed increased confidence in identifying overdose signs, knowing when naloxone is needed, and feeling prepared to administer it. This initiative highlights pharmacists’ critical role in strengthening community health literacy.

Introduction

Opioids are one of the most prescribed medications today, with a patient population of all ages.^1-3 The use and misuse of opioids can result in intentional or unintentional overdose. In the US, opioids were the leading cause of accidental death in 2024, resulting in 220 deaths per day.¹ Synthetic opioids such as fentanyl are causing the rapid increase in overdose mortality due to their
potency—about 50 to 100 times more potent than morphine.² Clinically underserved populations, in both domestic and rural locations, are at high risk for opioid overdose.³ Factors that put these populations at risk include a lack of education about opioid use and a shortage of health care professionals to deliver accurate instructions on how to use opioids and what to do in the event of an overdose.^1,3

Many community members may be unable to recognize the signs of an opioid overdose without education and training from a clinician. Clinical pharmacists and pharmacy learners can positively impact health literacy and medication safety among these underserved populations with patient education on safe opioid use, the signs of overdose, and layperson training on the use of naloxone in the event of an opioid overdose. Incorporating culturally competent and easily accessible education materials could assist in reducing the stigma of opioid use disorder and ultimately aim to reduce the number of opioid overdoses, in turn, keeping patients safe.

Objective

The purpose of this research was to assess the impact of pharmacy learner–led educational interventions on community knowledge and self-reported confidence in recognizing and responding to opioid overdoses with naloxone. This research was specifically targeted toward medically underserved populations, where access to overdose educational materials and naloxone may be limited, to identify effective strategies for improving community preparedness and harm reduction.

Methods

This Institutional Review Board–exempt study, conducted through Florida A&M University (FAMU), utilized clinical faculty and pharmacy learners to provide collaborative layperson naloxone administration training and education to the rural and underserved communities in Pensacola and Crestview, Florida, to improve health literacy and health-related outcomes surrounding opioid use. Funding was awarded by the FAMU Faculty Research Awards Program to an overseeing faculty member to support research and training surrounding the PrepOD Initiative. Three training and educational events took place in fall 2025, with one each at the FAMU Durell Peaden Jr Rural Pharmacy Education Campus in Crestview, a medically underserved clinic in Pensacola, and a public university campus in Pensacola.

At the events, participants were asked to complete an initial Likert scale presurvey, assessing their health literacy and comfort level surrounding opioid and naloxone use. Participants were provided layperson naloxone administration training and education led by pharmacy learners and pharmacists, along with patient education handouts and brochures. After training, participants were asked to complete the same Likert scale survey. The surveys were anonymous and collected at the time services were offered, and there was no patient follow-up.

The Table lists the 10 statements provided on the pre- and postsurveys. For each question/statement, participants were expected to identify whether they strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree. Presurvey and postsurvey results were compared to assess improvement in participant health literacy after receiving layperson naloxone training and patient education. Participants were provided with informed consent and could opt out of the training at any time.

Results

The results of the surveys show significant improvement in overdose knowledge and confidence in the administration of naloxone. Before the training, 45% of the survey participants overall agreed that they had sufficient knowledge regarding responding to opioid overdoses, while 55% disagreed or strongly disagreed. After the training, 97% of the participants agreed overall that they had gained sufficient knowledge regarding responding to opioid overdoses, while only 3% disagreed or strongly disagreed. Confidence in helping others who may be experiencing an opioid overdose and feeling sufficiently informed to administer naloxone safely also increased after the training (15%-92% and 25%-98%, respectively). Overall, the training was associated with significant improvement in overdose knowledge and confidence for opioid overdose recognition, response, and naloxone safety and efficacy.

Discussion

The naloxone education training yielded significant improvements in participant knowledge and self-sufficiency related to overdose recognition and naloxone administration. These findings are consistent with prior studies showing that patient education plus health literacy interventions instill confidence and provide knowledge in response to emergency situations.^4-7 This study shows that pharmacist-led education can improve overall health literacy surrounding naloxone use in underserved populations. The ability to provide medication-based knowledge in patient-friendly language, the accessibility of care to patients, and reliable health care information position pharmacists and pharmacy learners as valuable members of the health care team in both community and professional settings.

The overall improvement in confidence and public education among study participants emphasizes the potential to use pharmacists and pharmacy learners as naloxone training educators in other areas, including community pharmacies, ambulatory care clinics, and academic institutions. An example of this could be incorporating naloxone overdose education into an advanced or introductory pharmacy practice experience for a pharmacy learner to deliver community-based training events as a community service activity under the supervision of a pharmacy preceptor. Another example could be utilizing pharmacy learners to provide naloxone education at an ambulatory care clinic visit, either during the patient’s appointment or in the waiting room.

Strengths of this study include a clear pre- and postsurvey study design, a focus on practical skills relevant to the participants, and high survey completion rates. Limitations include a small sample size, the loss of data from 2 individuals who did not complete the postsurvey, possible self-report bias, and a lack of information about long-term knowledge retention or successful naloxone administration reports outside the initial training, such as an additional knowledge assessment or some kind of actual naloxone use post training assessment. Despite the limitations, the overall improvement adds to the intervention’s educational value. Future research could include a larger sample size, a more diverse group of participants, and further follow-up to assess long-term knowledge retention and the application of newly developed skills in the real world. Adding qualitative feedback and culturally appropriate outreach could further boost engagement and overall long-term impact.

Conclusion

Educating the audience about naloxone has improved knowledge, confidence in usage, and readiness for an opioid overdose. The posttraining survey demonstrated participants’ better understanding of the signs of an opioid-induced overdose, knowing where to acquire naloxone, and knowing how to administer it. By building from existing evidence supporting educational interventions, the findings show the pharmacy team's impacts on improving health literacy and preventing opioid overdoses in underserved communities.^1-3 They are effective at harm-reduction strategies and implementing effective community health literacy. Achieving more educational events through community pharmacies and academic partnerships will fortify overdose prevention awareness in high-risk populations.

REFERENCES

1. Understanding the opioid overdose epidemic. CDC. June 9, 2025. Accessed August 30, 2025. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html

2. Fentanyl. National Institute on Drug Abuse. June 2025. Accessed August 30, 2025. https://nida.nih.gov/research-topics/fentanyl

3. Mack KA, Jones CM, Ballesteros MF. Illicit drug use, illicit drug use disorders, and drug overdose deaths in metropolitan and nonmetropolitan areas — United States. MMWR Surveill Summ 2017;66(19):1-12. doi:10.15585/mmwr.ss6619a1

4. Nutbeam D, Lloyd JE. Understanding and responding to health literacy as a social determinant of Health. Annu Rev Public Health. 2021;42:159-173. doi:10.1146/annurev-publhealth-090419-102529

5. Wittink H, Oosterhaven J. Patient education and health literacy. Musculoskelet Sci Pract. 2018;38:120-127. doi:10.1016/j.msksp.2018.06.004

6. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107. doi:10.7326/0003-4819-155-2-201107190-00005

7. Office of the Surgeon General (US); Office of Disease Prevention and Health Promotion (US). Proceedings of the Surgeon General's Workshop on Improving Health Literacy. National Institutes of Health; 2006. Accessed August 29, 2025. https://www.ncbi.nlm.nih.gov/books/NBK44260/