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CLINICIAN'S CAPSULE What is known about the topic? Not all patients at risk of opioid overdose accept emergency department (ED)-based take-home naloxone (THN). What did this study ask? Why do at-risk ED patients refuse or accept THN? What did this study find? Those refusing THN felt: 1) not at risk of overdose; or 2) their ED visit was not the right time or place for THN. Those accepting THN wanted to save the lives of others. Why does this study matter to clinicians? Those refusing ED THN may accept THN elsewhere if referred to appropriate community services for overdose risk education and THN distribution.