Layout 1 Introduction Deaths from unintentional drug overdoses in Australia have almost doubled from 981 in 2001 to 1,654 in 2022 (Penington Institute, 2022). Compelling in number alone, this statistic does not convey the emotional pain that family and friends are left with or stigma due to the nature of their loved one’s death (Daley et al., 2018). Adding to potential emotional pain is the possibility that death could have been prevented by administration of naloxone—an opioid an- tagonist that has a high affinity for opioid receptors, thus temporarily blocking the effects of opioids. Substantial ev- idence supports the provision of naloxone for opioid toxi- city management, and therefore, naloxone has been used to treat opioid overdose for more than thirty years (Camp- bell, 2019; World Health Organization, 2014). “Take-home naloxone” (THN) is a term used to refer to the provision of naloxone to anyone potentially likely to witness an opioid overdose in the community. THN pro- grams have been evidenced to reduce overdose mortality in program participants and the wider community (McDon- ald & Strang, 2016; Strang et al., 2019). THN programs usually include overdose education detailing prevention strategies, how to identify and respond to opioid overdose including seeking help, and how to administer naloxone “It can save your life, that’s all I know,” barriers and facilitators for engagement in take-home naloxone for people receiving opioid substitution treatment in regional Australia: An explorative study Isabella Natale,1 Craig Harvey,1 Pene Wood,2 Karen Anderson2 1Drugs and Alcohol Services, Barwon Health, Geelong; 2La Trobe University, Bendigo, Australia ABSTRACT Engagement in take-home naloxone (THN) programs by people receiving opioid substitution treatment (OST) in Australia is low despite methadone being a significant contributor to opioid overdose deaths. Our aim was to explore barriers and facilitators for OST patients to engage in THN. We used a descriptive qualitative de- sign with thematic analysis to gain insight into naloxone uptake by people engaged in an OST program in regional Australia. Eleven participants were interviewed; eight had previously en- gaged with THN. Barriers to THN included limited knowledge and understanding, lack of information, and not personally ex- periencing an overdose. Facilitators included having a traumatic experience of overdose, knowledge and understanding of THN and overdose, empowerment in carrying naloxone, and expand- ing THN programs. Support for the expansion of THN programs is desired among participants, and widespread peer distribution is understood to be the key to success. This study found that prior traumatic experience of overdose facilitates acceptance of THN, and being offered THN was the most important factor in engagement. Less clear is how to engage people who lack a trau- matic overdose experience. Correspondence: Isabella Natale, Drugs and Alcohol Service, Bar- won Health, PO Box 281, Geelong 3220, Australia. Tel.: +61.426.193.972 - Fax: +61.3.4215.8793. E-mail: Isabella.Natale@barwonhealth.org.au Key words: Methadone; take-home naloxone; overdose; opioid- use disorders; buprenorphine. Conflict of interest: The authors declare no potential conflict of in- terest, and all authors confirm accuracy. Ethics approval and consent to participate: Written informed con- sent was obtained prior to all interviews. Ethics approval was ob- tained from the Research Ethics, Governance & Integrity Unit (Reference 19.123) at Barwon Health and the University Human Ethics Committee at La Trobe University. Patient consent for publication: Written informed consent was ob- tained from a legally authorized representative(s) for anonymized patient information to be published in this article. Availability of data and materials: All data generated or analyzed during this study are included in this published article. Acknowledgements: The authors acknowledge the participants for their time and willingness to share often traumatic experiences for the purposes of this study. Received: 12 September 2022. Accepted: 7 May 2023. Publisher’s note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affil- iated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Qualitative Research in Medicine & Healthcare 2023; 7:10868 doi:10.4081/qrmh.2023.10868 This article is distributed under the terms of the Creative Commons Attribution-NonCommercial International License (CC BY-NC 4.0) which permits any noncommercial use, distribution, and reproduc- tion in any medium, provided the original author(s) and source are credited. [page 34] [Qualitative Research in Medicine & Healthcare 2023; 7:10868] Qualitative Research in Medicine & Healthcare 2023; volume 7:10868 No n- co mm er cia l u se on ly (Williams et al., 2014). These programs are targeted to- wards people who are likely to witness an opioid overdose in the community and are well-placed to intervene (Strang et al., 2019). Naloxone was first made available for use outside the hospital setting in Italy in 1991 in response to a heroin epi- demic (Campbell, 2019). In the late 1990s, naloxone pro- vision began in the United States and in the early 2000s, programs began in the United Kingdom (Campbell, 2019). In 2010, Scotland became the first jurisdiction to imple- ment a national THN program (McAuley et al., 2012), and in 2014, the World Health Organization endorsed wide- spread availability of naloxone for community management of opioid overdose (World Health Organization, 2014). THN programs commenced in Australia in 2012 in the Australian Capital Territory and now operate in all Aus- tralian jurisdictions (Dwyer et al., 2018). Currently, three different formulations of naloxone are available in Aus- tralia: an intranasal spray and two intramuscular injection options—one pre-filled and the other requiring additional equipment to utilize. Naloxone has been available via GP prescription—subsidized on the Pharmaceutical Benefits Scheme since 2012—and for people to purchase over the counter in pharmacies since 2017 (Dwyer et al., 2018). As of July 2022, all pharmacies in Australia have been able to access federal funding to dispense naloxone for free to cus- tomers, and changes to legislation in the state of Victoria will soon enable people other than pharmacists, such as harm reduction workers, to supply naloxone (Australian Government Department of Health and Aged Care, 2022). Prior to July 2022 and despite product and program availability, economical and logistical barriers to accessing naloxone in Australia were evident (Dwyer et al., 2018). For people likely to be present at a drug overdose, the cost to purchase naloxone over the counter, fear of experiencing stigma, and future discriminatory consequences if naloxone was requested were prohibitive (Green et al., 2017). Patients prescribed opioid substitution treatment (OST) (methadone and buprenorphine) contribute to over- dose deaths; while their medication alone does not rou- tinely cause the death, it often plays a significant part (Penington Institute, 2022). This is contrary to public opinion that the methadone implicated in overdose deaths has been diverted and highlights the current relevance and need for THN programs for patients on OST (Jamieson, 2020). In Australia, the rate of accidental deaths involving methadone more than doubled from 2001 to 2020 (Pen- ington Institute, 2022). Times of increased risk of overdose are at commence- ment of treatment, when take-away doses are commenced, and at cessation of treatment (Walley et al., 2013). Risks are present at commencement as dosage has not been sta- bilised and patients are more likely to be continuing use of illicit or prescribed opioids (Walley et al., 2013). Take-away doses increase the availability of the medication, and at ces- sation, tolerance is often significantly reduced. Despite OST patients demonstrably making effort to reduce or cease opioid use, they continue to have high rates of over- dose risk factors such as polysubstance use and relapse leading to increased exposure to overdose events (Walley et al., 2013). Major barriers to obtaining naloxone in Australia have been identified as out-of-pocket cost to the consumer and difficulties navigating complex health systems (Dwyer et al., 2018) similar to experience in the United States (Deer- ing et al., 2018). The cost of naloxone available over the counter in Australian pharmacies until July 2022 was pro- hibitive to the person at risk of overdose (Pricolo & Nielsen, 2018). To obtain naloxone at a subsidized price through the pharmaceutical benefits scheme, people must first obtain a prescription from their GP and then have that prescription filled at a pharmacy. The stigma and discrim- ination from such health services and health professionals (Fomiatti et al., 2022; Strang et al., 2019; Van Boekel et al., 2013) is compounded by the often inaccurate per- ceived notion of wrongdoing by requesting naloxone, adding another significant barrier to obtaining THN from a pharmacist. Additionally, people receiving methadone view concurrent use of opioids, benzodiazepines, and al- cohol as low risk, despite evidence that this is particularly fatal (Deering et al., 2018). Government funding of THN programs in Victoria began free provision of naloxone in 2018, thus overcoming the financial barrier. As part of a strategy to increase nalox- one distribution, naloxone was offered to all OST patients attending medical appointments at a drug and alcohol serv- ice in regional Victoria. Experienced reception staff offered free provision that would include a brief training to be car- ried out by experienced harm-reduction staff while patients waited to see their GP, thereby overcoming both financial and logistical barriers. Despite this, many OST patients de- clined take-home naloxone, in contrast to the literature, sug- gesting that other barriers remain (Deering et al., 2018; Dwyer et al., 2018). This qualitative study, therefore, ex- plores persistent potential barriers and facilitators to OST patients. Materials and Methods We used a descriptive qualitative design (Sande- lowski, 2010) with semi-structured interviews in a re- gional town in Victoria, Australia. We recruited participants from a community-based drug and alcohol service that offers access to OST prescribing GPs and a take-home naloxone program among other related harm reduction services. This service is the largest service for people accessing OST in the region. Eleven semi-structured interviews (30-90 minutes in length) were conducted by the lead researcher (IN) and audio recorded. The initial six interviews were conducted face-to-face during February and March 2020, followed by five telephone interviews in July and August 2020, to com- [Qualitative Research in Medicine & Healthcare 2023; 7:10868] [page 35] Article No n- co mm er cia l u se on ly ply with physical distancing restrictions in place in Victoria at the time due to COVID-19. Adults over the age of 18 who were being prescribed OST at the time of interview and had been offered THN in the past were purposively recruited (Lavrakas, 2008). Prospective participants who were unable to participate in an interview face-to-face or via telehealth were excluded. All staff at the service were provided with information about the study prior to advertising, posters being placed in waiting areas of the site. Prospective participants were asked to contact the lead researcher to confirm eligibility and discuss interview arrangements. Written informed consent was obtained prior to all in- terviews. Ethics approval was obtained from the Research Ethics, Governance & Integrity Unit (Reference 19.123) at Barwon Health and the University Human Ethics Commit- tee at La Trobe University. The interview guide (Supplementary Materials, Appen- dix 1) was developed for this study based on the literature (Deering et al., 2018; Dietze, Stare, et al., 2018) and re- viewed by experienced clinicians working with OST pa- tients and THN programs. The interview guide was used to explore narratives from participants pertaining to their drug use history leading to OST, their knowledge and experience of overdose, and particularly their attitudes towards take- home naloxone programs and any experience they had with naloxone. This method enabled us to utilize open-ended questions, inviting the participants to give a more detailed response and allowed for further questioning if deemed rel- evant to the study. Recruitment continued until there was consistency in the concepts and insights into people’s ex- perience of naloxone and opioid overdose emerging with- out presentation of new themes (Fusch & Ness, 2015). Data analysis Data were analysed utilizing thematic analysis (Sande- lowski, 2010). This is a systematic approach that involves identifying themes or patterns of cultural meaning: coding and classifying data and interpreting the resulting the- matic structures. Interviews were transcribed verbatim, and data were then de-identified, coded, and analysed. Ini- tial data were coded separately by all researchers and compared for consistency, after which all remaining data were coded by two researchers (IN and CH). Codes were sorted into themes which all researchers met to discuss and compare. Commonalities, relationships, context, and patterns were considered before themes were refined (Liamputtong, 2009). Results Eight males and three females took part in this study, and the median age range was 36-45 years (Table 1). Of the 11 participants, 10 were prescribed methadone, and eight had engaged with THN prior to the study. The gender, age, and OST medication type characteristics matched na- tional data for OST patients in Australia in 2019 (Australian Institute of Health and Welfare, 2020). Three participants had casual work as peer needle and syringe workers; how- ever, for the most part, participants’ income consisted of government support. All had access to housing, and educa- tion levels varied from degree qualifications to leaving school prior to year 10. Themes emerging from interviews were grouped into barriers to engaging with THN and facilitators of engaging with THN. Barriers to engaging with THN were limited knowledge and understanding of THN, lack of information on THN from GPs and pharmacists, not personally experi- encing an overdose, and using drugs alone. Facilitators that emerged included having a traumatic experience of over- dose, knowledge and understanding of THN and overdose, the belief that having THN is empowering, and expanding THN programs. Each of these themes is discussed below, and the words of the participants are used to illustrate the themes reported. Pseudonyms have been used throughout. In general, all participants deemed accessing THN as [page 36] [Qualitative Research in Medicine & Healthcare 2023; 7:10868] Article Table 1. Participant characteristics. Gender Age OST Accepted THN Participant 1 Male >60 Methadone Yes Participant 2 Male 46-60 Buprenorphine/naloxone Yes Participant 3 Male 36-45 Methadone Yes Participant 4 Male 36-45 Methadone Yes Participant 5 Male 26-35 Methadone Yes Participant 6 Female 36-45 Methadone Yes Participant 7 Female 46-60 Methadone Yes Participant 8 Male 36-45 Methadone No Participant 9 Male 36-45 Methadone No Participant 10 Female 36-45 Methadone No Participant 11 Male 36-45 Methadone Yes OST, opioid substitution treatment; THN, take-home naloxone. No n- co mm er cia l u se on ly easy, and not being able to obtain naloxone did not con- tribute to anyone’s decision to accept naloxone or not. Cost or logistical issues were not raised by any participants as contributing factors; therefore, access was not identified as contributing to barriers or to facilitators. Theme 1: Barriers to engaging with THN Several barriers to engaging with THN were identified by participants; these included a lack of understanding about THN and the risk of overdose, not personally expe- riencing an overdose, and using drugs alone. Limited knowledge and understanding of THN Participants were asked about their understanding of THN including what it is used for, who they think should use it, and why and how it can be accessed. Among par- ticipants who had not engaged with take-home naloxone, understanding that naloxone reversed an overdose and that participants could access it was all that was known. For example, William said, “Naloxone, I know you can just give it to them, or you know it all depends on the person using…. You give it to them, and they’ll wake up from an overdose.” Similarly, Carol explained “It can save your life, that’s all I know” and Paul agreed with, “No, I wouldn’t know. I wouldn’t even know what it looked like.” Lack of information on THN from GPs and pharmacists When asked if their OST prescriber or a pharmacist had ever discussed THN with them, only one participant reported that their GP discussed take-home naloxone with them; others voiced a desire for this to occur. For instance, Carol said, “He doesn’t talk to me about that kind of stuff…. It would actually be good; it would actually feel like he cares.” This tendency was explored further with participants who had been co-prescribed central nervous system depressant medications that would increase their risk of toxicity and overdose. In such cases, Naloxone was still not discussed or offered by their doctors—“Nope…. Nah never, not one doctor,” as William succinctly ob- served. William interpreted this as supporting his view at the time that he was not at risk of overdose and did not need THN. This view was then reinforced by dispensing pharmacists not discussing THN either: “Nope, never. Not one, not any chemist.” It wasn’t until later when he was offered THN by a harm reduction worker that he was in- formed of the potential overdose risks. This pattern was common across all participants ex- cept for Carol who said it felt good to be asked about naloxone by the chemist: “The chemist was asking peo- ple.… It was good to know it was out there for an option, if needed.” A lack of education on overdose risks and THN from GPs and pharmacists could have been a con- tributing factor to the limited knowledge participants had on THN and could explain why their understanding was limited to the risk of overdose. Not personally experiencing an overdose All participants who declined THN had no personal ex- perience of an overdose and even indicated that THN was for people who had overdosed previously, highlighting their limited understanding of THN, as evidenced by Paul: “Peo- ple that are, you know…. I don’t, I don’t know. Like to be honest. I don’t know people that are, have, have overdosed before? You know, at least once or twice.” By assuming that THN was for people who had overdosed previously, participants excluded themselves from this group. Participants who had not engaged with THN could not explain why they had never had an overdose them- selves and did not have strategies to reduce their own overdose risk, and some, such as Paul, believed that the risk to themselves was low or non-existent: “[I]t’s not going to happen to me.” When specifically asked what strategies were employed to reduce their overdose risk, Tim also downplayed the risk: “I don’t know. Nothing I suppose.” We interpreted that this denial of overdose risk, combined with not employing any risk reduction strategies, led participants to determine that THN was not relevant to them. Using drugs alone Using drugs alone was a barrier to engaging with THN. Participants who used alone and had not engaged with THN reasoned that if a person were alone and experiencing an overdose, then THN was not relevant, as they could not ad- minister it to themselves: “[I]f you’re by yourself it’s not going to save anyone’s life.” Comments like this implied a fatalistic view of the risks of using drugs alone. Theme 2: Facilitators promoting engagement with THN Traumatic experience of overdose All participants who had engaged with THN had expe- rienced a traumatic overdose event, and all had personally overdosed at least once. Also, many had experienced an overdose fatality or near miss of someone they identified as close to them, and that affected them deeply, as demon- strated by Ralph: “[M]y friends who I started using heroin with. There was seven of us, and there’s only two of us left. So the rest are dead.” Participants linked these experiences as informing their decision to engage with THN, as de- scribed by Terry and Mark, respectively: “Because of her, I automatically, yeah, wanted it,” and “[J]ust my experi- ences in the past and stuff like that to know that I could’ve like done something to change the, the defects, was a no brainer”. For these participants, it appears that traumatic overdose events pre-determined their engagement with THN when the offer was made. [Qualitative Research in Medicine & Healthcare 2023; 7:10868] [page 37] Article No n- co mm er cia l u se on ly Knowledge and understanding of THN and overdose Participants who had accepted THN generally had good knowledge of what naloxone is, its intended use, and the concept of THN programs. Attitudes towards being able to access it themselves were positive, and three participants in this group reported having administered naloxone. Mark stated, “Just basically, that it reverses the effects of the, of the opiates,” and William concurred with, “You give it to them, and they’ll wake up from an overdose.” The effect of naloxone was thus described simply, and feelings of con- fidence in naloxone and competence to respond to an over- dose were evident. It is not clear whether this knowledge facilitated engagement with THN programs or was a result of having accepted THN previously. Additionally, this same group gave detailed explana- tions as to why people overdose and outlined various risk reduction strategies utilized to prevent overdoses from oc- curring. Common strategies included using their drugs in multiple, smaller amounts, not using alone, and being aware of their tolerance. For example, Russell explained that “Two holes in the arm is better than one in the ground,” and William said, “You know I always, I only do two points at that time. You know, I know me sort of thing, me toler- ance. Do you know what I mean like?” Similar to knowl- edge of THN, it is not clear whether utilizing risk reduction strategies facilitated engagement with THN programs or was a result of the engagement. Having THN is empowering Participants who had used their THN to reverse opioid overdoses described feelings of empowerment, control, and gratitude at being able to take action to prevent harm. Mark, for instance, likened it to being a paramedic, and others ex- pressed relief at having the tools and knowledge to act in potentially life-threatening situations: “[I]t’s yeah, just amazing to, to be able to have that kind of control and, yeah, ability.” And William reflected on how it is different now with access to THN compared to fifteen years ago: At least you can bring them back to life now, you know what I mean. Like, we couldn’t do that. You had to get the ambulance to do it. And then nine out of ten, they’re going to die because the time the am- bulance got there it was too late. As Mark and William’s comments reveal, having access to naloxone and being able to administer it with confidence enables OST patients to feel empowered. Expanding THN programs All participants were supportive of THN programs re- gardless of whether they had used THN. Suggestions to ex- pand THN distribution included peer distribution, targeting drug dealers, making it compulsory via needle syringe pro- grams, and including THN kits in syringe vending ma- chines, as demonstrated by Sandra and Tim respectively: “I think drug dealers should have it” and “Yeah, they should maybe hand it out with every kit pack…. Compulsory, put it in their pack. Make it that they don’t it get it unless they take it home.” Furthermore, all participants—regardless of whether they had or had not engaged with THN—supported peer distribution of THN and reported that it was already hap- pening informally. For example, Sandra acknowledged that some people were still not willing to engage with commu- nity THN programs, noting that “people are scared of peo- ple who have authority.” And Ralph suggested that peer distribution could reach this group of people: “[W]e’ve been able to get ourselves, not just ourselves to have the naloxone, but other people, who come in here and wouldn’t engage with, with staff.” Through comments such as these, participants reflected about how they and other peers have a role in distributing THN to people who are not being reached by THN programs and are potentially at high risk of overdose, suggesting that peer distribution facilitates ac- cess to THN. Distribution via peers and syringe vending machines were suggested as ways to reduce barriers for people not wanting to engage with THN program staff. The benefits of THN and importance of ensuring access to those who needed it were voiced by all participants. Discussion In this study, significant barriers existed for OST pa- tients deciding whether to accept THN such as limited knowledge and understanding, not experiencing an over- dose themselves, and using alone. The experience of a trau- matic overdose, however, was a facilitator to engaging with THN, and naloxone need only be offered to such partici- pants to facilitate engagement. Participants clearly desired the expansion of THN programs and viewed widespread peer distribution as the key to success. Consistent with these findings, Deering et al. (2018) report that opioid users who do not engage with THN pro- grams have poor knowledge and understanding of over- dose and naloxone (Deering et al., 2018), and this has been identified as an area for improvement (Dietze, Stare, et al., 2018). Findings of this study support the importance of improving knowledge of overdose and naloxone among this population and thereby decreasing barriers to accessing THN. Some participants said that their GP and/or pharmacist had never discussed THN with them, strengthening self- perceptions regarding low risk of overdose. This is also a missed opportunity for increasing awareness and avail- ability of THN. Despite barriers such as workflow logis- tics and costs related to limited time (Strang et al., 2019), evidence presented here further supports the belief that GPs should co-prescribe naloxone with opioids (see also, Strang & McDonald, 2016) and that pharmacists dispense [page 38] [Qualitative Research in Medicine & Healthcare 2023; 7:10868] Article No n- co mm er cia l u se on ly naloxone with opioids (see also, Choremis et al., 2019). In Australia, work is progressing in determining and ad- dressing barriers for pharmacists (Nielsen et al., 2021; Strang et al., 2019; Van Boekel et al., 2013); however fur- ther research needs to determine barriers for GPs in Aus- tralia, particularly in rural settings. These findings further indicate that never having expe- rienced an overdose personally contribute to the ambiva- lence pertaining to perception of one’s own risk and play a role in participants deciding not to accept THN, as did using opioids alone. This has not been identified in the literature previously. Participants were focused using naloxone on themselves rather than the thought of using it on someone else. This finding has implications for overdose education and THN program delivery to ensure accurate understand- ing of the relevance of naloxone, thereby enabling people to make informed choices. The data clearly demonstrate that a traumatic overdose experience (of oneself or witnessed) preclude engagement with THN. For the population represented in this study, it is imperative that naloxone is put in their hands, as experi- ence of an overdose has been identified as a strong predic- tor of subsequent overdose (Boyes, 1994). In addition to preventing harm, this will increase knowledge and under- standing of naloxone, overdose risk factors, and risk reduc- tion strategies, as demonstrated in this study and others (Dietze, Draper, et al., 2018; Lintzeris et al., 2020). Addi- tionally, having THN may have an empowering effect (see also, McAuley et al., 2018; Wagner et al., 2014). A chal- lenge remaining is how improved knowledge regarding both overdose and the use of naloxone can be achieved among people who do not engage in such programs and is an area for further research. Based upon this research, OST patients desire an ex- pansion of THN programs regardless of whether they per- sonally choose to accept it, and peer distribution will contribute to reaching people who are not willing or able to engage with non-peer employees of THN programs (see also, Lenton et al., 2015; Nelson et al., 2016; Olsen et al., 2015). This pattern emphasizes the unique position peers have within their community and the additional credibility and trustworthiness conferred on them by patients when talking about overdose. Recent changes to legislation in Victoria (Foley, 2020) will enable this practice on a much larger scale than exists as of this writing. Limitations to this study include a small number of par- ticipants in one regional Victorian location only. Charac- teristics of the participants in this study were similar to the population of OST patients in Australia; however, further research with a larger sample would be necessary to confer transferability of findings to other contexts, situations, and times (Australian Institute of Health and Welfare, 2020). Further, views sought were on perceptions of risk as op- posed to actual practices, and precluding overdose risk fac- tors outside opioid using behaviours—such as smoking, renal function, alcohol intake, and other relevant co-mor- bidities—were not explored. Finally, the number of partic- ipants who did not accept THN was small and may not be representative of the views of all OST patients who do not accept THN. Conclusions This study found that prior traumatic experience of overdose amongst OST patients facilitates acceptance of THN. For this group, the relevance of THN programs was clear, and being offered THN was the most important fac- tor in their engagement. Less clear is how to engage peo- ple who have not had a traumatic experience because access to and the offer of THN was not enough to confer acceptance of naloxone. Barriers identified, such as poor knowledge and denial of one’s own risk, warrant further investigation for implications about overdose prevention and THN program implementation. Expansion of peer distribution of THN in Australia is supported by these findings; however, we suggest that to do this successfully, peer workers must be recognized, remunerated, and sup- ported equitably in the workforce. While this study has sought to develop greater under- standing into the reasons why OST patients accept THN or not, “THN is not a panacea for overdose. It is a last re- sort for those on the brink” (McAuley et al., 2018). THN programs only address one part of the prevention and re- sponse to opioid overdose and should be seen in this con- text. There is still much work to do to address the broader social, environmental, and legislative issues that overdose occurs within. References Australian Government Department of Health and Aged Care. (2022, 30 August 2022). Take home naloxone program. 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