Take-home naloxone in secure settings: a clinical audit of uptake, practice gaps and service improvement

Background People leaving custody face a high risk of opioid overdose, particularly within the first 2 weeks post-release due to reduced tolerance, disrupted treatment, and an increasingly volatile synthetic opioid market. National guidance recommends take-home naloxone (THN) provision with training, yet uptake in secure settings remains inconsistent.Methods A clinical audit evaluated THN uptake against an 80% benchmark. Eligible participants were opioid-dependent individuals or those at risk of overdose who received naloxone education before release. Monthly data from March to November 2025 were collected from psychosocial records, SystmOne documentation, and governance reports. Barriers were identified, targeted interventions implemented, and re-audit undertaken in February and March 2026.Results Baseline uptake ranged from 28.6% to 42.0%. Barriers included stigma, abstinence identity, inconsistent documentation, communication gaps, and missed opportunities at release. Governance-aligned interventions, particularly a SystmOne release-ledger prompt, improved uptake to 55.0% in February and 68.0% in March 2026.Conclusions Governance-led workflow changes reduced missed opportunities and improved THN uptake, although performance remained below the 80% benchmark. Structured prompts and multidisciplinary communication may support more consistent overdose-prevention practice in secure settings.