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

Background: Naloxone training and supply are used in the Republic of Ireland (ROI) and Northern Ireland (NI) to reduce opioid drug-related deaths. An evidence-based intervention, the supervised injection facility (SIF), is part of government policy in ROI, but has not yet been implemented. In NI, SIF is not yet part of government policy. This reflects a research-to-practice gap in both contexts. The current study examined the barriers and facilitators to implementing SIF interventions in ROI and NI in order to reduce opioid drug-related deaths.
Methods: Twenty-three one-to-one semi-structured interviews 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 was a barrier to interventions at both micro (community, local GP’s and police) and macro (media) levels. Regarding micro-barriers, policing and community intimidation were present in both ROI and NI. In contrast, threats of paramilitary violence towards people who use drugs were unique to NI. Macro-barriers identified were delays in municipal government and apathy from policy makers regarding SIF implementation. Peer to peer naloxone delivery and amending legislation to facilitate non-prescription naloxone were suggested by ….as important policy initiatives. Stakeholders recommended communication of positive experiences of using naloxone via webinars, Town Halls, and a Citizens’ Assembly as a means of supporting intervention implementation.
Conclusion: Cross-environmental (social and policy) and multi-level (macro and micro) stigma reduction and policy advocacy efforts that incorporate the positive experiences of people who use drugs may help to increase uptake of SIFs. This may bridge the research-to-practice gap to help reduce drug-related deaths on the island of Ireland and in international settings.