# The implementation of take-home naloxone: Lessons learned from a 3-year take-home naloxone project in Germany

## TL;DR

This paper summarizes lessons from a 3-year project in Germany to distribute take-home naloxone, a life-saving drug for opioid overdoses, and highlights challenges and recommendations for future efforts.

## Contribution

The study provides insights into the implementation challenges and success factors of a nationwide take-home naloxone project in Germany.

## Key findings

- Only 1,451 out of 2,333 people who use opioids received take-home naloxone during the project.
- The prescription-only status of naloxone hindered its availability to those at highest risk of overdose.
- Implementation of naloxone distribution was uneven across German federal states, with Bavaria being the most active region.

## Abstract

Take-home naloxone (THN) can prevent deaths related to opioid overdoses. Despite the first THN project in Germany in 1998, the availability of naloxone for people who use opioids (PWUO) is still scarce. We present the results of the German-wide THN-project NALtrain, which aimed to implement THN nationwide. Firstly, we present data collected during NALtrain and secondly, we use this data to critically reflect on the project and thereby draw conclusions that could inform future THN projects.

NALtrain was conducted between July 2021 and June 2024. Descriptive statistical analysis of the documentation of 74 train-the-trainer events and following naloxone trainings conducted by the trained staff were carried out.

864 staff members from approximately 373 organizations (mainly harm reduction services) participated in 74 train-the-trainer courses. Of the 373 organizations 123 conducted 784 naloxone trainings for PWUO and reached 2,333 PWUO, of whom 1,451 received THN. The goal of training 800 staff members was met, while the goals of reaching 400 organizations and 10,000 PWUO were missed. The implementation of THN is unevenly distributed across the German federal states, especially concentrated in Bavaria. The core learnings are that the prescription-only status of THN leads to extra organizational efforts and hinders the availability of THN for individuals with the highest risk of overdose.

Considering the proportion of organizations offering THN, they can still be classified as “early adopters”. These may serve as role models for the broader majority. Free available THN and centrally coordinated support of implementation including recurring follow-up can be key to a broader availability of THN in Germany. In future initiatives physicians and medical settings should be prioritized.

864 staff members from approximately 373 organizations were trained.

About 123 organizations conducted 784 naloxone trainings and reached 2,333 people who use opioids (PWUO), of whom 1,451 received THN.

Prescription-only status of THN hinders availability of THN for PWUO.

Physicians and medical settings should be involved in an early stage and prioritized in future THN projects.

Centrally and ongoing coordination, support and follow-up is vital for long term implementation of THN.