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

Nicole Miller, Claire Campbell, Gillian W Shorter

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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 supervised injection facility. Tailoring stigma campaigns to incorporate the lived experience of people who use drugs, their family members and the general community who have interventions to reduce overdose in their local area 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.
Original languageEnglish
Article number104049
Early online date27 May 2023
Publication statusPublished (in print/issue) - 31 Jul 2023

Bibliographical note

Funding Information:
The authors gratefully acknowledge the contribution of Dr Bethany Waterhouse-Bradley and Dr Orla McBride during the data analysis process and Chris Rintoul for his mentorship for NMM. The authors would like to thank the study participants for their time and contribution to the research.

Publisher Copyright:
© 2023


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


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