Background <p>The opioid epidemic continues to be one of the most pressing public health crises in the United States, with more than 80,000 overdose deaths in 2024. Syringe services programs (SSPs) play a critical role in expanding access to naloxone, a lifesaving opioid antagonist medication. While community-based naloxone distribution has been shown to increase community capacity to respond to overdoses, less is known about how individuals’ overdose experiences and naloxone access interact over time.</p> Methods <p>We analyzed administrative data from 136 people who use drugs who completed at least three quarterly follow-up assessments at an SSP in Miami, FL. Cross-lagged panel models were specified to examine the bidirectional, longitudinal associations between (1) recent overdose experiences and naloxone receipt during SSP visits, and (2) naloxone receipt during SSP visits and the likelihood of having naloxone available when needed.</p> Findings <p>Our analysis showed that recent overdose experiences were strongly predictive of receiving naloxone at subsequent SSP visits, and that receiving naloxone at the SSP was associated with a lower likelihood of reporting overdose experiences at future time points. We found no significant effect of receiving naloxone on later reports of having naloxone when needed, but we observed that participants who reported having naloxone when needed were more likely to receive naloxone at subsequent SSP visits.</p> Discussion <p>These findings highlight the dynamic, reciprocal nature of overdose risk and naloxone engagement over time. They reinforce the critical role of SSPs as ongoing points of access and re-engagement to enhance and sustain overdose prevention efforts.</p>