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

Abstract Background 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 t...

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Main Authors: Simon Fleißner, Larissa Steimle, Dirk Schäffer, Bernd Werse, Daniel Deimel, Maria Kuban, Heino Stöver
Format: Article
Language:English
Published: BMC 2025-07-01
Series:Harm Reduction Journal
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Online Access:https://doi.org/10.1186/s12954-025-01281-1
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author Simon Fleißner
Larissa Steimle
Dirk Schäffer
Bernd Werse
Daniel Deimel
Maria Kuban
Heino Stöver
author_facet Simon Fleißner
Larissa Steimle
Dirk Schäffer
Bernd Werse
Daniel Deimel
Maria Kuban
Heino Stöver
author_sort Simon Fleißner
collection DOAJ
description Abstract Background 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. Method 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. Results 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. Conclusion 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.
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spelling doaj-art-94e2718366114323ba57162fc78fef3c2025-08-20T03:42:27ZengBMCHarm Reduction Journal1477-75172025-07-012211910.1186/s12954-025-01281-1The implementation of take-home naloxone: Lessons learned from a 3-year take-home naloxone project in GermanySimon Fleißner0Larissa Steimle1Dirk Schäffer2Bernd Werse3Daniel Deimel4Maria Kuban5Heino Stöver6Faculty of Social Sciences, Technical University Nuernberg Georg Simon OhmInstitute of Addiction Research, Frankfurt University of Applied SciencesGerman AIDS FederationInstitute of Addiction Research, Frankfurt University of Applied SciencesFaculty of Social Sciences, Technical University Nuernberg Georg Simon OhmGerman AIDS FederationInstitute of Addiction Research, Frankfurt University of Applied SciencesAbstract Background 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. Method 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. Results 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. Conclusion 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.https://doi.org/10.1186/s12954-025-01281-1Opioid overdoseOverdose emergency trainingHarm reductionTake-home NaloxoneImplementation
spellingShingle Simon Fleißner
Larissa Steimle
Dirk Schäffer
Bernd Werse
Daniel Deimel
Maria Kuban
Heino Stöver
The implementation of take-home naloxone: Lessons learned from a 3-year take-home naloxone project in Germany
Harm Reduction Journal
Opioid overdose
Overdose emergency training
Harm reduction
Take-home Naloxone
Implementation
title The implementation of take-home naloxone: Lessons learned from a 3-year take-home naloxone project in Germany
title_full The implementation of take-home naloxone: Lessons learned from a 3-year take-home naloxone project in Germany
title_fullStr The implementation of take-home naloxone: Lessons learned from a 3-year take-home naloxone project in Germany
title_full_unstemmed The implementation of take-home naloxone: Lessons learned from a 3-year take-home naloxone project in Germany
title_short The implementation of take-home naloxone: Lessons learned from a 3-year take-home naloxone project in Germany
title_sort implementation of take home naloxone lessons learned from a 3 year take home naloxone project in germany
topic Opioid overdose
Overdose emergency training
Harm reduction
Take-home Naloxone
Implementation
url https://doi.org/10.1186/s12954-025-01281-1
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