Key findings:

• Naloxone awareness significantly increased in each consecutive year, across 2022-2025.
• Among those who had heard of naloxone, the per cent reporting past year uptake increased in 2025 relative to 2024.
• Participants who had seen a drug alert in the previous 12 months or who had engaged in past year drug checking (personal test kits or at a service) had significantly higher odds of past year naloxone uptake.
• Participants who used methamphetamine in the past six months or who had high levels of psychological distress also had higher odds of past year naloxone uptake.

Discussion: The significant increases in both naloxone awareness and uptake among these samples of people who regularly use illicit stimulants in Australia represent a significant harm reduction achievement. This progress is particularly salient in the context of an evolving global drug market and the increasing presence of high potency synthetic opioids, which heighten potential overdose risk for individuals who may be unknowingly exposed through adulterated products. Nonetheless, a persistent gap between awareness and uptake indicates the need for continued and targeted efforts to strengthen access to naloxone.

Past year exposure to drug alerts and engagement with drug checking were both significantly associated with past year naloxone uptake. Although the cross-sectional nature of these data precludes causal inference, these associations are unsurprising given that opioid related drug alerts routinely include messaging encouraging people to carry naloxone (2), and most drug checking services operating in Australia distribute naloxone while also delivering harm reduction education. It is therefore likely that these services play a direct role in facilitating increased naloxone awareness and uptake, underscoring their importance in promoting harm reduction behaviours. At the same time, it is plausible that individuals who engage with drug alerts and drug checking are already more proactive in adopting multiple harm reduction strategies and may have been aware of or obtained naloxone prior to these interactions.

Taken together, these findings underscore the value of embedding naloxone education and distribution within established harm reduction infrastructure, while also considering strategies to extend reach beyond these settings.