Scaling up Harm Reduction: Results of the 3-year Take-Home Naloxone project NALtrain in Germany.

Background: 

Naloxone is an opioidantagonist, can reverse opioidoverdoses within minutes and is easy to administer by lay-persons. The beginning of one of the earliest take-home naloxone initiatives globally occurred in Berlin in 1998. However, subsequent projects were local, and only a handful of drug-aid facilities conducted regular naloxone training. In 2018, Bavaria initiated a model project in its cities, followed by a 3-year nationwide model project called NALtrain (Naloxone-Training) funded by the Ministry of Health (07/2021-06/2024). The WHO and the EMCDDA endorsed the widespread implementation of take-home naloxone as a preventive measure, which, despite these early projects, has hardly succeeded so far in Germany. This presentation delves into the ongoing project's outcomes of NALtrain and the challenges encountered in scaling up take-home naloxone. As of the abstract submission, the project is ongoing, and the results are reflective of the not fully evaluated data until December 2023.

Method: 

Between January 2022 and December 2023, we conducted over 70 train-the-trainer workshops, targeting diverse professionals working with people who use opioids (PWUO), including social workers and physicians. These workshops engaged nearly 600 participants, primarily from low-threshold drug-aid facilities but also from prisons, rehab centres, and substitution ambulances. Professionals trained in naloxone then conducted sessions for over 2000 PWUO, with subsequent evaluations. Additionally, efforts were made to gather support from various associations and ministries for the broader implementation of take-home naloxone.

Results: 

Approximately 30% of the trained professionals offered naloxone training, with up to 12 months between participating in the workshop and offering naloxone training. Once an institution has started with naloxone training, this is usually followed by more trainings. 60% of the 2000 PWUO received naloxone immediately post-training. Notably, the reached PWUO were predominantly from four of Germany's 16 federal states. Feedback from nearly 100 overdose reversals indicated that none resulted in fatalities, and the use of naloxone was deemed appropriate, while only 50% called an ambulance.

Conclusion: 

While implementing take-home naloxone in Germany is feasible, it has yet to be universally implemented. Insufficient financial support, limited involvement of addiction physicians, and the inadequate integration of naloxone training in diverse settings hinder its broader adoption. The prescription-only status of naloxone nasal spray in Germany necessitated strong collaboration between drug-aid facilities and local physicians, a significant impediment to the project. Challenges included organizational issues and physicians' willingness to participate. In contrast to the undisputed acknowledgment of naloxone's life-saving potential in the USA and Canada, its acceptance remains a matter of contention in Germany.