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IntroductionNaloxone is an effective emergency antidote to opioid overdose. Increasing availability of take-home naloxone (THN) may reduce overdose deaths from heroin and other opiate drugs. We explored stakeholder perspectives of the processes, feasibility and acceptability of THN distributed in emergency settings as part of a feasibility study for a randomised controlled trial (RCT).MethodsWe conducted qualitative semi-structured interviews (12 participants) and a focus group (8 participants) with Emergency Department staff and paramedics. We transcribed interviews verbatim and used Normalisation Process Theory to guide data collection and analysis.ResultsParticipants perceived emergency service provision of THN as a low cost, low risk intervention and demonstrated coherence in understanding the aims of the trial and how it related to their work practices. Paramedics in particular recognised benefits of THN as distinct from naloxone alone and valued the additional provision of training and education, compatible with ‘making every contact count’. Participants reported limited opportunities for THN provision to this cohort due to low engagement from eligible patients, but perceived there to be high potential benefit for a subset of emergency service users who would not otherwise access THN. Provision of THN to patients during the trial was low due to limited numbers of eligible patients, high turnover of trained staff and recruitment pauses due to protocol changes and Covid-19. Determination of effectiveness was perceived to be challenging within a trial due to high levels of community provision of THN. There was overall support from ED and paramedic staff for the roll out of emergency setting provision of THN as standard practice, outside the confines of a trial.ConclusionsDistribution of THN in emergency settings appears to be feasible and acceptable for stakeholders and may widen access to THN for users not engaging with wider community drug services. Further RCTs of THN in emergency settings may be limited by difficulties in recruitment and limited opportunity to recruit new patients, where THN provision from other settings is widespread.

IntroductionUK clinical guidelines recommend that provision of Take Home Naloxone (THN) to heroin and other opiate users can reduce mortality and morbidity in this population. Emergency departments (ED) and ambulance staff could provide ideal opportunities for THN distribution, due to regular encounters with patients experiencing opioid overdose. As part of a wider feasibility study for emergency service provision of THN, we explored user perspectives on feasibility and acceptability of THN, based on previous knowledge and experience of overdose.MethodsWe conducted qualitative, semi-structured interviews with a sample (n=26) of people who use opiates attending drug treatment outpatient clinic or third sector drug organisation in three UK cities. We analysed data using thematic analysis.ResultsRespondents had significant experience of overdose (experienced personally or witnessed) and high awareness and understanding of overdose management, including personal experience of THN use. Respondents identified some barriers to THN provision at the time of overdose, e.g. reluctance to engage with health professionals at the time of opioid withdrawal but overall were highly supportive of increased access to THN. Service users perceived THN as an acceptable and easy to use intervention, valuing provision of THN via ambulance or ED staff in addition to community provision. THN training and provision gave respondents a sense of self-agency and empowerment and an opportunity to potentially save the lives of others. Respondents wanted more opportunities for friends and family to also undergo training and receive the THN kits.ConclusionPeople who access services for their opioid use support increased provision of THN from a wider variety of providers including ED and ambulance staff but also extending to other community support services. Extending THN provision to peers and family of people at risk of overdose could also offer additional opportunities to improve outcomes from opioid overdose events.

BackgroundAlcohol Intoxication Management Services (AIMS), commonly known as ‘drunk tanks’, provide an alternative to emergency department (ED) attendance for intoxicated adults at times of high incidence. The EDARA study evaluated the role of AIMS in the emergency care system and night time economy. Here we present findings describing AIMS activity and running costs, and estimating the effect of AIMS on ED attendance rates and ED user experience.We identified six cities with AIMS and collected data relating to attendances and costs of running the service. We matched these cities with six cities without AIMS and used routine NHS data to estimate the effect of AIMS operation upon ED attendances during hours of AIMS activity. We also surveyed ED user experience over matched time periods of AIMS activity in cities with and without AIMS.Mean attendance rates at the AIMS ranged from 2.7 to 11.8 per night. The mean running cost for an AIMS was £1635 per night (range £1075 to £2265) and the mean cost per attendance was £222.50 (range £132.27 to £583.8). Overall AIMS were associated with reduced ED attendances (−5.30 per night, p<0.05, 95% CI −9.62 to −0.62). However, the effect varied markedly between individual AIMS, ranging from 4.93 fewer attendances to 3.32 additional attendances per night. There was no significant effect from AIMS on ED user aggregate service rating score (coefficient 0.060, p=0.372), perception of feeling threatened (−0.037, p=132), aggregate negative experience score (−0.147, p=0.196), and overall service rating score (0.25, p=0.440).AIMS vary markedly in activity, running costs and effect on ED attendances, so estimating overall effects is probably inappropriate. The most active and expensive AIMS appeared to be associated with the greatest effect on ED attendances. We identified no effect on ED user experience.