Naloxone Use, Carrying Practices, Prior Training, and Confidence in Overdose Response Among Attendees of a 4-Day Music Festival in Colorado.

Abstract

The contamination of non-opioid drugs with fentanyl presents a risk at US music festivals, where environmental factors exacerbate overdose-related risks. Naloxone is an opioid antagonist medication that can be used by festival attendees to reverse opioid overdose. We conducted a field survey at a 4-day Colorado music festival (N=227) to characterize attendees' prior experience with naloxone and to investigate whether attendees carry naloxone with them in both festival and non-festival settings. We also assessed attendees' level of confidence in responding to an overdose with naloxone and asked attendees to report any barriers they experienced to carrying naloxone at festivals. Prevalence of carrying naloxone in any context was 55.5% (N=126). Festival carriage was more common than carriage in non-festival settings, with 55.1% reporting at least "sometimes" carrying at festivals compared with 32.7% outside festival settings. In addition, 8.4% had used naloxone to respond to an overdose, and 4.4% had personally been administered naloxone. Among participants who reported carrying naloxone, 65.3% had never received training. Regarding confidence in overdose response, 29.9% of naloxone carriers reported being only "slightly confident" or "not at all confident." Barriers included access, festival restrictions and legal concerns, lack of education, training, and awareness, convenience factors, and perceived responsibility of carrying naloxone. Findings highlight the need for increased naloxone access, training, and awareness among festival attendees. Actionable recommendations include free or low-cost naloxone distribution, on-site training, and transparent entry policies to reduce barriers and promote overdose response as a community responsibility.