Development, implementation and liquidation of a national Danish Train-the-Trainer system 2010 - 2023

Background: project SAVE LIFE, developed from 2010 to 2023 through a series of connected projects has explored training in very diverse settings, from a localized health-clinic over a growing number of communities to national training of drug treatment staff.  In 2019, a change in legislation and guidelines led to a demand for municipalities to educate substance users in overdose treatment and provision with Take-Home-Naloxone (THN). A legislative amendment in 2022 ensured that provision of nasal naloxone, no longer required a prescription but could be ordered by authorized nurses.  This represented a significant expansion of options for THN courses.

Activities: In 2020, SAVE LIFE was given the task of disseminating the model of training to 72 communities and 4 private providers of substitution treatment covered by the change in guidelines. 

The training concept was optimized with the aim of application to very different municipalities but still based in a systematic training setting. This ensured a good standard for the trainer group regardless of affiliation and secured the municipalities' access to consistent teaching. 

Methodology: The fundamental method employed was a Train-The-Trainer model, where a single coordinating body could deliver teaching competencies to relatively large staff groups over a short period. The coordinating body visited all relevant municipalities and trained on-site. The course was structured to ensure that all trainers were trained to a standard. Each municipality received at least two training sessions during the project period to ensure continuity. All trainers underwent a 4-hour manualized training, and was provided a package of trainer manuals and teaching templates and demo material complying with the WHO 2014 recommendations.  Demographic data, municipal affiliations and profession, were recorded in Center for Alcohol and Drug Research. A database associated with individual municipalities was supposed to register the training of substance users at the front/helper level, but due to the simultaneous lockdown of large parts of society because of the COVID-19 epidemic, registration did not function satisfactorily.

Results: 550 trainers across the country were trained over a period of 2½ years in 85 training sessions. A network between individual trainers and municipalities was established and was functioning during the project period but proved challenging to maintain without continuous contact with the coordinating unit.

Discussion: Results from the nationwide project will be presented. The change in legislation and consequences of easier access to naloxone nasal spray will be put into perspective. Evolution of recommendations from the 4 project phases is described, along with the consequences of the shutdown of the coordinating body. Finally, a model for early detection and reporting of new psychoactive substances in a sentinel system, which could have utilized the network and nationwide coordination is described