The short version
- In a study of 61 US fishing vessel captains, only 5 vessels (8.2%) carried naloxone and only 10 captains (16.4%) had been trained to use it[1].
- A Massachusetts analysis found fishing workers died of opioid overdose at more than five times the rate of all workers in the state[3][4].
- Naloxone is not a controlled substance and has been sold over the counter since March 2023[5]. It can go in the chest without a DEA registration.
- The label says store it between 36°F and 77°F, do not freeze, and avoid heat above 104°F[6]. A wheelhouse dashboard in July fails that test.
The data says most boats are not ready for an overdose
Two studies asked fishermen directly. Both found the same gap: crews that know naloxone exists, and boats that do not carry it.
| Study | Who was asked | Finding |
|---|---|---|
| Bartlett et al., 2023[1] | 61 US fishing vessel captains | 8.2% of vessels carried naloxone; 16.4% of captains trained |
| Same study[1] | Captains’ level of concern | 86.7% “not at all worried” about a crew overdose |
| Dennistoun et al., 2026[2] | 25 Washington fishermen, mostly shellfish harvesters | 54% knew how to give naloxone, yet 91% did not carry it aboard |
| Same study, after training[2] | Same group | 70% planned to add naloxone to their first aid kits |
The risk behind those numbers is documented. Davis and colleagues coded every opioid-related overdose death among Massachusetts residents from 2011 to 2015 by occupation, and found construction and fishing workers stood out with rates many times the all-worker average[3]. The state report behind it put fishing at more than five times the average[4]. The study linked higher rates to jobs with high injury rates, job insecurity and little paid sick leave[3]: a description of a deckhand’s working life.
Can a vessel carry naloxone without a DEA registration?
Yes. FDA states that naloxone has no abuse potential and is not a controlled substance, and it approved the first over-the-counter nasal spray in March 2023[5]. That puts it outside the controlled substance rules that govern the rest of the chest.
| Question | Morphine or other opioid in the chest | Naloxone |
|---|---|---|
| Controlled substance? | Yes; held under 21 CFR 1301.25[9] | No[5] |
| How it is bought | Registered medical officer, or master’s written requisition[9] | Over the counter[5] |
| Required by federal rule? | Depends on the vessel and flag | Not named in 46 CFR 28.210 or FDA’s ship chest guide[7][8] |
Neither 46 CFR 28.210 nor FDA’s compliance guide for ships’ medicine chests sets a contents list[7][8]. Carrying naloxone is the operator’s decision. The vessels that carry opioid pain relief for injuries have the strongest case for carrying the reversal agent next to it. For the controlled side, see 21 CFR 1301.25 explained.
Why an overdose at sea is harder than one ashore
The over-the-counter label is written for a shore emergency. Its steps are check, give, call 911, watch and give again, and stay until the ambulance arrives[6]. Two lines matter more at sea than on land.
- Repeat dosing. If the person does not wake, the label says to keep giving doses every 2 to 3 minutes, and warns you may need to give all the doses in the pack[6]. One device per boat is not a plan.
- Relapse after waking. The label says to give another dose if the person becomes very sleepy again[6]. Offshore there is no ambulance crew to hand over to, so someone has to watch the patient for hours, not minutes.
- Waking symptoms. Shaking, sweating, nausea or anger on waking are expected, per the label[6]. Brief the crew so a waking patient is not restrained or left alone.
That is why the naloxone decision belongs inside a medical escalation plan that says who calls for medical advice and when a patient comes off the boat. See when to medevac a seafarer.
Where to keep it on a boat: the label’s temperature limits
The Drug Facts label sets the storage range: room temperature or refrigerated between 2°C and 25°C (36°F to 77°F), do not freeze, avoid excessive heat above 40°C (104°F), and protect from light[6]. Each device sits in a sealed blister and must not be used if the blister is open or torn[6].
| Location aboard (example) | Label risk[6] | Verdict |
|---|---|---|
| Wheelhouse dash or window ledge | Heat above 104°F, light | Avoid |
| Engine room | Heat above 104°F | Avoid |
| Unheated deck locker, winter | Freezing | Avoid |
| Galley or accommodation, in the first aid kit | Usually inside 36°F to 77°F | Use, and log the check |
Temperature damage and expiry are the two ways a device fails silently. Put naloxone on the same dated list as the rest of the chest; the method is in expired medicines on ships.
A five-step naloxone setup for a vessel
- Stock more than one dose, because repeat dosing may use every device in the pack[6].
- Store it in the first aid kit, inside the label temperature range, away from light[6].
- Train more than the captain. Only 16.4% of captains in the national study were trained[1]; the person who finds the patient may be a deckhand.
- Write it into the medical plan: who gives it, who calls for advice, who watches the patient.
- Record every use, and treat a death aboard as a possible serious marine incident: one or more deaths from a reportable marine casualty qualifies[10]. See death on board: the US procedure.
Discovery Health MD adds naloxone to fleet programs as part of the whole chest, not as a loose item. The stock, storage and dating sit in ship medical chest management; the opioid pain relief it reverses sits in controlled substances management; and the overdose response plan is written through maritime medical consulting. Ask us to add naloxone to your fleet plan.
Common questions
Should commercial fishing vessels carry naloxone?
No federal rule names it[7][8], but the case is strong: fishing workers had overdose death rates more than five times the state average in Massachusetts[4], and only 8.2% of surveyed vessels carried it[1].
Is naloxone a controlled substance?
No. FDA states it has no abuse potential and is not a controlled substance[5]. It does not need the DEA route used for chest opioids[9].
Do you need a prescription to buy Narcan?
No. FDA approved the first over-the-counter naloxone nasal spray in March 2023[5].
How should naloxone be stored on a boat?
Between 36°F and 77°F, not frozen, away from heat above 104°F and out of light, in its sealed blister[6]. A first aid kit in the accommodation usually fits; the engine room does not.
How many doses should a vessel carry?
More than one. The label says to repeat a dose every 2 to 3 minutes if the person does not wake and warns all doses in the pack may be needed[6]. Size it to your crew and trip length; see how to stock a ship medicine chest.
Can the overdose come back after naloxone?
The label tells the rescuer to give another dose if the person becomes very sleepy again and to stay with them[6]. At sea, plan for a long watch and a medical call.
Is an overdose death aboard a serious marine incident?
A reportable marine casualty that results in one or more deaths is a serious marine incident under 46 CFR 4.03-2[10]. See serious marine incident testing.
