Date of Award
Spring 2026
Document Type
Open Access Dissertation
Department
Health Promotion, Education and Behavior
First Advisor
Shan Qiao
Abstract
Introduction: Fatal opioid overdose remains the leading cause of injury-related death in the United States. Naloxone serves as a primary method of harm reduction in the opioid epidemic as it is an opioid antagonist that reverses the symptoms of an opioid overdose (e.g., respiratory depression, loss of consciousness) momentarily (i.e., 30 to 90 minutes) until further medical care can be provided. Despite the increased accessibility of naloxone through its formulation as a nasal spray and federal and state-level policies (e.g., Naloxone Access Laws [NALs], Good Samaritan Laws [GSLs]), there persist barriers to acceptance and implementation (e.g., knowledge gaps, stigma) that require further exploration and identification to be effectively addressed (i.e., Aim I and Aim II). Further, state-level GSLs have been emergently enacted over the last two decades, but vary in their protections from arrest, charges, or prosecution, including variation in their protection of individuals on probation or parole when seeking emergency medical care in the event of an opioid overdose (i.e., Aim III). These barriers to naloxone acceptability and the varying extent to which parole protections are afforded require further investigation to inform public health communication, intervention, and policy.
Methods: Aim I) A content analysis was conducted to identify emergent topics within naloxone-related tweets and a sentiment analysis was run to explore spatiotemporal patterns of naloxone-related sentiment across the U.S. The analyses were conducted using data extracted from a repository of historic, geotagged tweets, where the sentiment analysis utilized the full sample (i.e., 3,611 tweets) and the content analysis relied on a random subsample of tweets (i.e., 25 per region, per year for a total of 500 tweets). Aim II) A content analysis was conducted, to explore emergent themes among key stakeholders, using video-based content extracted from TikTok (i.e., 150 videos). All videos were analyzed following an inductive content analysis method where latent meanings (e.g., body language, visuals) within the data were considered as the data were coded, grouped, and described with emergent themes. Aim III) A longitudinal analysis was conducted using data that were merged (i.e., using county-level Federal Information Processing System [FIPS] codes) from multiple, publicly available sources (i.e., Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research [CDC WONDER] system, American Community Survey [ACS], and the Prescription Drug Abuse Policy System [PDAPS]). The merged data were relied upon in the longitudinal analysis (i.e., 2018-2022), in which a generalized linear mixed model was run, with the outcome of opioid overdose mortality, alongside key sociodemographics, social determinants of health (SDOH), and policy variables.
Results: Aim I) The content analysis of a random subsample of tweets identified emergent themes of primarily positive (i.e., naloxone endorsement, naloxone education, naloxone availability, resource and program sharing, destigmatization, harm reduction endorsement) and negative messaging (i.e., naloxone opposition, stigma perpetuation). The sentiment analysis illustrated an overall negative sentiment, within naloxone-related tweets, across the regions of the U.S. between 2018 and 2022, but demonstrates fluctuations in some regions (i.e., West, Northeast) that are necessary to consider in the tailoring of health communication and education efforts. Aim II) Most TikTok videos contained a positive messaging polarity related to naloxone by expressing endorsement, providing education, or communicating acceptance, but there persisted negative messaging that perpetuated stigma against and mocked naloxone and people who use drugs or opioids (PWUD/O). The distribution of content amongst stakeholders, by message polarity, demonstrates the commitment of harm reduction organizations (HROs) to provide educational and destigmatizing content while the pervasiveness of stigmatizing videos posted by healthcare providers (HCPs) requires further attention to avoid perpetuating stigma and exacerbating inequities. Aim III) Overall, time (IRR=1.17, p< .0001), percentage of the county: within an age group (i.e., 18 to 34 [IRR=1.03, p< .0001], 35 to 64 [IRR=1.07, p< .0001], 65 and over [IRR=1.03, p< .0001]), identifying as Black (IRR=1.01, p< .0001), identifying as White (IRR=1.01, p< .0001), holding less than a high school diploma (IRR=1.02, p=.0002), unemployed (IRR=1.04, p< .0001), and experiencing poverty (IRR=1.01, p< .0001) were positively associated with opioid overdose mortality. The interaction between GSL parole protections and time (IRR=0.96, p< .0001) reflects a deceleration of opioid overdose mortality in counties, within states, with these expanded protections, where annual opioid overdose mortality is reduced by 4% each year.
Conclusions: The findings of the present work demonstrate persistent stigma enacted towards naloxone and PWUD/O, while simultaneously demonstrating efforts of creators to disseminate harm reduction and naloxone-related education and destigmatizing narratives on social media platforms (i.e., X/Twitter, TikTok). Regional based findings serve to inform the tailoring of health education and communication based upon the prevalence of negative sentiment in naloxone-related discussions across the country. At the structural level, the present findings support the extant literature that has identified inequities and disparities, amongst vulnerabilized populations, and contributes evidence that suggests GSL parole protections may aid in reducing opioid overdose mortality. The implications of this work, that suggest states adopt GSL parole protections, should be considered alongside the ramifications of ongoing criminalization and calls for system reforms to avoid further perpetuating ongoing health inequities and disparities as we aim to mitigate the preventable morbidity and mortality associated with the opioid epidemic.
Rights
© 2026, Camryn Michael Garrett
Recommended Citation
Garrett, C. M.(2026). An Evaluation of Naloxone Sentiments and Policy Considerations Within the Context of the U.S. Opioid Epidemic. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/8791