Peer Naloxone Project Toolkit

A practical guide to implementation

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Introduction

The voices of people with living and lived experience of substance use are central to the work of Scottish Drugs Forum. We are committed to ensuring peers have meaningful opportunities to shape services and contribute to decision-making at every level.

We have significant experience of delivering Peer Naloxone Projects designed to improve community responses to overdose, increase access to naloxone and support peers to take an active role in saving lives.

This toolkit shares our learning and provides a practical, step-by-step guide for organisations looking to deliver Peer Naloxone Projects across Scotland.

A note on terminology

Throughout this guide, ‘peer’ is used to mean someone with living or lived experience of substance use.

What is a Peer Naloxone Project?

Naloxone is a safe and easy-to-use life-saving medication that can reverse the effects of an opioid overdose. It can be administered as an injection or a nasal spray. You do not need to be a medical professional to carry or administer naloxone.

As SDF, we believe that strengthening community distribution of naloxone can and does save lives.

Peer Naloxone Projects empower people with experience of substance use to deliver training and supply naloxone to people who are likely to witness an overdose.

Peer Naloxone Projects can:

Improve reach into communities that services may not access

Increase confidence and awareness around naloxone and overdose responses

Complement – not replace – professional services and emergency responses

Gareth Balmer, National Harm Reduction Lead at WithYou, says the Fife Peer Naloxone Champions project has shown what’s possible when you trust people with lived experience and value that experience properly.

He explains:

“Partnering with Scottish Drugs Forum, we recruited four champions and embedded them as paid sessional workers within our harm reduction team in Fife.

“The biggest hurdle was convincing services that we were genuinely willing to employ people who might still be using drugs. Once we worked through that, the impact was significant.

“In their first year, the champions distributed more than 450 naloxone kits. Take-home naloxone distribution across Fife increased by 60% on the previous year.

“More than the numbers, the champions became a core part of our service, training community organisations, running outreach across Fife, and reaching people that professional staff simply couldn’t.”

Who can deliver a Peer Naloxone Project?

Peer Naloxone Projects can be delivered by harm reduction services, third sector organisations and community groups, amongst others.

In our experience, projects are best developed by organisations that are already active in local communities and are therefore well placed to:

understand local needs

provide safe conditions and support

ensure alignment with national naloxone guidance

maintain consistent naloxone supply and delivery pathways

The role of the peer

Who can be a peer?

Effective Peers typically:

have experience of substance use

are motivated to increase naloxone availability among people who use drugs to help prevent drug-related deaths

understand the challenges faced by people who use drugs and engage in ways that are respectful and effective

are trusted within their communities

What do peers do within Peer Naloxone Projects?

Peers typically:

provide naloxone, along with information and informal training

engage with people

identify individuals likely to witness an overdose – through outreach and opportunistic engagement

contribute to National Peer Naloxone Network discussions and events, sharing experience and practice locally and nationally

What else should we consider?

It is important to recognise that:

Peers are not support workers

There is no expectation for peers to disclose personal experiences

Wellbeing and personal boundaries must always be prioritised

Should peer roles be paid, or can they be voluntary?

In our evaluation of the SDF Peer Naloxone Project Pilot, we made the following recommendation:

“All peer workers involved in projects of this kind, including those within prison settings, must be paid fairly for their time. This will allow the role to be recognised as important work and ensure peers are valued. Some peers chose to volunteer and did not want to be paid; this option should be considered as appropriate but must be chosen by the peers.”

Providing payment where appropriate can increase uptake and show Peers that you really value their input.

Where full employment is not possible, organisations may approach their Peer Naloxone Project as sessional work.

Whatever approach you choose to take, it is important to be consistent, fair and transparent.

Impact on benefits

Taking on a Peer role may have an impact on an individual’s benefit payment. While your organisation may be unable to provide information on an individual’s specific case, you should signpost them to organisations that can provide independent advice and clear information to help peers make informed decisions.

Citizens Advice Scotland

Entitled To Benefit Calculator

How to recruit to your Peer Naloxone Project

Information sessions

Holding an information session is a helpful first step, allowing you to:

gauge and build community support

explain the peer naloxone project, including roles and expectations

create a safe space for questions and discussion

offer practical and emotional support to access interviews

If your organisation is already active in the community, it may be that you already have a ‘warm audience’ to invite to your information session. If not, you could liaise with other local charities and support services to identify people who may be interested.

Holding interviews

Not everyone applying will have previous interview experience. It is your responsibility to create a safe, respectful and accessible process.

Good practice includes:

using clear, non-judgemental language

asking open-ended questions

maintaining confidentiality

being mindful of triggers and offering support

checking digital access if holding online interviews

Wondering what questions to ask? We recommend keeping it short and informal, and focuses on the person’s motivations – why are they interested in your Peer Naloxone Project?

Support with ID and PVG requirements

Your organisation may have a policy of asking new staff and volunteers to provide ID and complete a Protecting Vulnerable Groups (PVG) check. We recommend that you support Peers through this process by:

providing clear, step-by-step guidance

emphasising that this is necessary due to safeguarding requirements – it’s not a judgment

providing reassurance that disclosures are considered in context

Training your new peers

SDF provides a bespoke two-day ‘train the trainer’ course specifically on Peer naloxone projects.

By the end of the course, participants can:

describe the scale of the drug death crises in Scotland
recall evidence-based overdose prevention and naloxone messages
demonstrate an understanding of Scotland’s National Naloxone Programme
identify observable signs and symptoms of a depressant overdose and advise of the appropriate response accordingly
demonstrate the skills and knowledge to provide training and to supply (if applicable) take-home naloxone to people who use opioids or those likely to witness an overdose
deliver training in overdose prevention, intervention and naloxone
provide awareness sessions to other people on overdose prevention/naloxone
be confident and competent to supply naloxone without the need for a prescription, completing and safely returning relevant paperwork to appropriate member of staff.

To find out more about this course, visit our Learning Centre

Equipping your peers for success

Emotional support

Speaking to people about their experiences with drugs – including near fatal overdose – can be emotionally demanding. You should provide regular supervision and check-ins, and ensure Peers have an opportunity to de-brief after sessions.

Build connection

Providing your Peers with branded items – such as t-shirts, lanyard or bags with your organisation’s logo – can help them feel part of your team, foster a sense of pride in the work and ensure they are identifiable when out in communities.

Practical resources

Provide your Peers with the materials they need to effectively engage with communities – such as:

naloxone demonstration kits

Stop The Deaths campaign materials

Don’t assume Peers have access to a laptop or smartphone. If digital tools are required, ensure devices are provided along with basic IT skills training.

Managing peers’ travel and subsistence costs

It’s important for your Peers to have a clear understanding of what your organisation will cover and how make claims – this could include reminding them to get receipts, keep meals costs within a certain bracket, and use public transport over private vehicles.

If you are asking Peers to cover sessions outside their local area, they may also require practical support to plan their journey.

Common challenges and our solutions

SDF began delivering Peer Naloxone Projects in 2017. Here are some of the challenges we’ve faced – and what’s helped us tackle them.

Challenge

You think you’ve recruited the ideal Peer and then their circumstances change and they can do longer be involved.

Solution

We recommend always recruiting a group of Peers rather than an individual. This means they can support each other, and the project can keep moving if one person drops out.

We also advise being flexible in your approach. You may be able to let a Peer step back for a short period of time and then re-engage when they feel able.

Challenge

Peers don’t feel embedded within your organisation.

Solution

This may be your Peers’ first job, or a return to employment after a significant break. Be patient and make sure they feel welcomed by inviting them into your offices and holding regular team meetings.

Challenge

Peers move on leaving smaller numbers and less people available to participate

Solution

Upskilling a local trainer to be able to provide a rolling training programme for new Peers as needed

Get more information to support your project

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