4.3 Article

Barriers and facilitators of naloxone and safe injection facility interventions to reduce opioid drug-related deaths: A qualitative analysis

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DOI: 10.1016/j.drugpo.2023.104049

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Drug -related deaths; Stigma; Naloxone; Supervised injection facility; Risk environment framework; Paramilitary; Overdose prevention centre; Drug consumption room

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This study aimed to identify barriers and facilitators to implementing naloxone and a supervised injection facility (SIF) to reduce opioid drug-related deaths in the Republic of Ireland (ROI) and Northern Ireland (NI). The findings highlighted stigma, police intimidation, and policy maker apathy as significant barriers to naloxone distribution and SIF implementation. Participants suggested peer-to-peer naloxone delivery and changing legislation as strategies to increase naloxone uptake, and recommended using webinars, Town Halls, and a Citizens' Assembly as advocacy tools for SIF implementation. Continued efforts to reduce stigma and increase accessibility to evidence-based interventions are crucial in addressing opioid drug-related deaths in ROI, NI, and beyond.
Background: Opioid drug-related deaths continue to be a significant public health concern in the Republic of Ireland (ROI) and Northern Ireland (NI). While both regions have implemented naloxone to reduce drug related deaths, there remains a gap in the implementation of a supervised injection facility (SIF). This study aimed to identify barriers and facilitators to implementing naloxone and a SIF to reduce opioid drug-related deaths in ROI and NI. Methods: Semi-structured interviews (n = 23) were conducted in ROI and NI with experts by experience (n = 8), staff from low threshold services (n = 9), and individuals involved in policy making (n = 6). Data were analyzed using coding reliability Thematic Analysis and were informed by the Risk Environmental Framework.Results: The findings illustrated that stigma within the media, health centers, and the community was a significant barrier to naloxone distribution and SIF implementation. Policing and community intimidation were reported to hinder naloxone carriage in both the ROI and NI, while threats of paramilitary violence towards people who use drugs were unique to NI. Municipal government delays and policy maker apathy were reported to hinder SIF implementation in the ROI. Participants suggested peer-to-peer naloxone delivery and amending legislation to facilitate non-prescription naloxone would increase naloxone uptake. Participants recommended using webinars, Town Halls, and a Citizens' Assembly as tools to advocate for SIF implementation.Conclusion: Local and regional stigma reduction campaigns are needed in conjunction with policy changes to advance naloxone and a SIF. Tailoring stigma campaigns to incorporate the lived experience of people who use drugs, their family members, and the general community can aid in educating the public and change negative perceptions. This study highlights the need for ongoing efforts to reduce stigma and increase accessibility to evidence-based interventions to address opioid drug-related deaths in the ROI, NI, and internationally.

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