Utilizing a train-the-trainer model for multi-site naloxone distribution programs.

Background: In order to have a substantial impact on overdose prevention, the expansion and scaling-up of overdose prevention with naloxone distribution (OPEND) programs are needed. However, limited literature exists on the best method to train the large number of trainers needed to implement such initiatives.

Methods: As part of a national overdose prevention strategy, widespread OPEND was implemented throughout multiple low-threshold facilities in Norway. Following a two-hour 'train-the trainer course' staff were able to distribute naloxone in their facility. The course was open to all staff, regardless of educational background. To measure the effectiveness of the course, a questionnaire was given to participants immediately before and after the session, assessing knowledge on overdoses and naloxone, as well as attitudes towards the training session and distributing naloxone.

Results: In total, 511 staff were trained during 41 trainer sessions. During a two-month survey period, 54 staff participated in a questionnaire study. Knowledge scores significantly improved in all areas following the training (p<0.001). Attitude scores improved, and the majority of staff found the training useful and intended to distribute naloxone to their clients.

Conclusion: Large-scale naloxone distribution programs are likely to continue growing, and will require competent trainers to carry out training sessions. The train-the-trainer model appears to be effective in efficiently training a high volume of trainers, improving trainers' knowledge and intentions to distribute naloxone. Further research is needed to assess the long term effects of the training session, staffs' subsequent involvement following the trainer session, and knowledge transferred to the clients.