Background: Despite widespread naloxone distribution efforts, opioid-involved overdose rates remain high, with rates in recent years indicating disproportionate increases in the death rate for Black residents. This study evaluated knowledge and perceived competency regarding opioid overdose and naloxone administration among urban Indiana residents. Methods: As part of a federally funded project (#CPIMP221346), the Indiana University Center for Survey Research conducted community probability surveys from March to May 2023, sampling 772 residents in Indiana's urban communities across 8 zip code areas. The study explored individual and community level factors affecting residents' knowledge and perceived competency regarding opioid overdose and naloxone administration. Results: Multilevel analysis identified race, sex, household income, education, length of time lived in community, and a history of opioid overdose as significant predictors of knowledge. Participants who identified as White scored a mean of 6.65 out of 10, those of Other races scored 5.75, and Black participants scored 5.70, on a 10 item questionnaire developed from the Overdose Knowledge Scale (OOKS) and the Opioid Overdose Attitudes Scale (OOAS) (p < 0.001). Additionally, there was significant cross-level interaction between race and poverty, such that Black residents living in poorer neighborhoods displayed lower knowledge scores than White counterparts (ꞵ = 1.06, p = 0.039). However, in terms of perceived competency, only age and a history of opioid overdose, were found to be significant predictors. Conclusions: These findings underscore the importance of community education to increase knowledge and perceived competency regarding opioid overdose and naloxone administration among Black populations particularly living in socioeconomically disadvantated areas.

The authors have declared no competing interest.

This project was supported by the Office of Minority Health (OMH) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award (CPIMP221346). The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by OMH/OASH/HHS, or the U.S. Government. For more information, please visit https://www.minorityhealth.hhs.gov/.

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This study was approved by the Indiana University Institutional Review Board (IUIRB), which determined that the research met the requirements for federal and University criteria for exemption (approved protocol ID: 16953). Informed consent was obtained for all participants. Waiver of documentation of consent was approved by the IUIRB.

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Data are not available due to personally identifiable information of study participants who were recruited from relatively small geographic areas (8 zip code areas) and sensitive data (e.g., illicit drug use).