Implementation and integration of a naloxone-based opioid overdose response protocol in organizations serving opioid users: A qualitative study

Purpose:

Instances of opioid overdoses are increasing across the country. As an evidence-based practice (EBP), Naloxone, an opioid antagonist, has been proven effective in reversing overdoses when administered intra-nasally. Utilizing Simpson and Flynn’s Organizational Readiness for Change (TCU-ORC) model, this study explores the decision-making processes guiding the implementation and integration of a naloxone-based opioid overdose response protocol (NBOORP) in organizations providing services to heroin and other opioid users in Western Massachusetts.

Methods:

Qualitative interviews were conducted with 75 program directors and staff from organizations which received naloxone responder training. Participants were asked (1) to describe the decision-making process that led to the implementation of their NBOORP, (2) how, if at all, the NBOORP was integrated into the organization’s service model, and, (3) if integrated, whether a NBOORP was currently and routinely used to reverse overdoses.  Participants completed a modified version of the TCU-ORC measures focusing on program needs, workplace stress, and staff’s perceived organizational influence.

Results:

Preliminary analysis shows a significant barrier to implementation is administrative concerns around organizational liability, especially in for-profit organizations. Most organizations implemented a NBOORP immediately after training and prior to developing a written policy. Additionally, the quantitative measures will assess the impact of perceived barriers and the organization’s readiness for change on its ability to implement a NBOORP.

Discussion:

The identification of characteristics linked to the successful implementation of a NBOORP will increase understanding of a model for rapid infusion of an EBP, Naloxone, for service providers offering a range of services to opioid users.