Currently, there is no national curricular standard for teaching medical students how to respond to an opioid overdose. At VCOM-Virginia, first-year medical students are trained using the Virginia-state naloxone training program (REVIVE!). This program, however, consists only of a lecture-based training with a pre- and post-training assessment. Prior to this study, there has never been a hands-on component or an assessment of long-term retention. This study was designed as a randomized control trial and took place at the VCOM - Virginia Campus’s Simulation Center. Participants include medical students at VCOM-VA who had never received naloxone training. We enrolled 255 participants, with 96 comprising the control group (w/o simulation) and 114 in the experimental (w/ simulation) after losing participants to follow up. IRB approval was received on 9/26/23 (VCOM IRB Record # 2023-132). The intervention offered to the control group was the unaltered Virginia REVIVE! course curriculum. The experimental group received the classroom-based curriculum, alongside a simulation experience utilizing a high-fidelity manikin synced to the Laerdal Learning Application software. Participants were tasked with assessing the manikin’s vital signs, deciding if their case was severe alcohol intoxication or opioid overdose, and following the rescue protocol as outlined in the didactic portion. All participants received the same 2 post-assessment surveys based on the learning objectives outlined in the REVIVE! course, one immediately following the didactic portion, and one at 6 months following their training date. Additionally, time to recognize a situation as an overdose and self-reported confidence scores were recorded from students following their simulation. At 6-month follow-up, there was a significant difference in average time to recognition between the simulation-trained group and control group. There was also a statistically significant difference in confidence in real world performance with a higher confidence seen in the simulation trained group. Additionally, the simulation-trained group had a smaller difference in post-assessment score change at the 6 month mark; however these results were not statistically significant, thus we can make no conclusions about long-term material retention at this time. Results of this study show that medical students who receive simulation training in opioid overdose rescue feel more confident and respond more quickly than those who receive traditional classroom-based training. In the larger context of medical education, these findings highlight the potential for simulation-based learning to enhance student preparedness and confidence in critical hands-on skills such as naloxone administration. A high-fidelity manikin approach could also be extended to other clinical skills, reinforcing the philosophy of patient-focused care through innovative teaching methods.