The implementation of take-home naloxone in Germany. An interview study with professionals who offer overdose education and naloxone distribution.

BACKGROUND

The number of opioid-related deaths in Germany has continued to rise in 2024. Take-home naloxone (THN) is an evidence-based intervention to prevent opioid-related overdose deaths. Pilot projects have existed in Germany since 1998; however, the implementation of THN is still scarce.

OBJECTIVE

The aim of this study is to explore external overarching barriers and facilitators affecting the implementation of THN in drug services.

METHOD: Twelve qualitative interviews were conducted with professionals who are involved in the implementation of THN in Germany. The data were analysed using qualitative content-analysis. Both data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). The analysis focuses on the "Outer Setting" domain of the CFIR.

RESULTS

The prescription and distribution requirement for naloxone and the lack of funding hinder organizations in implementing THN. Successful collaborations with physicians and other local stakeholders act as facilitators. Stigma and legal uncertainties can hinder the initiation of such collaborations. The professional and political pressure to implement THN is low, resulting in many organizations struggling to find local partners for joint implementation.

CONCLUSION

Central coordination of THN dissemination and long-term implementation could support the development of local networks, help reduce stigma, and clarify legal misconceptions. Allowing naloxone to be distributed free of charge and without prescription to people who use opioids (PWUO) appears essential for effective THN implementation. Legal clarity regarding naloxone prescription could encourage more physicians to engage in THN. The results might be relevant for the implementation of THN in other countries as well.