•Significant decreases in rates of overdose, injection heroin use, and sharing syringes or cookers among IDU participants from baseline to 6 months suggest effectiveness of intervention
•Obtaining a naloxone kit was not associated with reporting injecting drug use or overdose at 6-months
•Although the voucher system helped link some participants to HIV treatment, many were reluctant to go to the City AIDS Center to exchange the voucher for a naloxone kit
•Given the barriers of the voucher system, we recommend easy access to nalxone:
–Distributing naloxone kits during intervention session (take home)
–Providing easy access to naloxone in pharmacies (over-the-counter)
•Opiate overdose associated with multiple HIV risks which suggests the potential efficacy of an integrated HIV/OD prevention intervention
•Training IDUs and their partners to administer naloxone is a feasible, safe and effective approach in preventing fatal overdose among IDUs and their network
•Use of naloxone averted fatalities during overdose events and participants/couples and their network used it safely
•Providing naloxone-based overdose prevention and naloxone kit increased recruitment and engagement of IDUs in this study
• Scaling up peer-driven Naloxone-based OD prevention is a feasible, low cost intervention that will not only save lives but will also engage IDUs in HIV prevention, testing, treatment