Background Opioids kill more people than any other drug. Naloxone is an opioid antagonist which can be distributed in take-home ‘kits’ for peer administration (THN). We aimed to determine the feasibility of carrying out a definitive randomised trial of THN in emergency settings.

Methods We carried out a randomised feasibility trial clustered by site, in paired ED and Ambulance Service (AS) catchment areas. Usual care was administration of naloxone by paramedics or ED staff. In addition to usual care at intervention sites THN was offered to adults in ED or by paramedics for a problem related to opioid use. We assessed feasibility of intervention and trial methods based upon predetermined progression criteria: site sign-up; training of staff; identification of eligible patients and the proportion given kits. We planned to retrieve anonymised outcomes for people identified as being at high risk of opioid-related death.

Results Four sites participated in the trial and 278 clinical staff were trained (ED1: 107, ED2: 25, AS1: 100, AS2 46). Sixty THN kits were supplied to patients during the 1-year recruitment period (ED1: 36, ED2 16, AS1: 4, AS2: 4). Eligible patients were not offered THN kits 164 times (ED1: 159, AS1, 2, AS2: 3). Reasons included: ‘forgot’ (n=136); ‘too busy’ (n=15); suspected intentional overdose (n=3). 626 people were considered but recorded as ineligible (ED: 532, ED2:4, AS1: 49, AS2:41). Reasons included: uncooperative (n=55); lacked capacity (n=35); reduced consciousness (n=41); in custody (n=21); absconded (n=161).

Conclusions This study did not meet progression criteria for intervention feasibility, so outcomes were not followed up and a fully powered trial is not planned. The emergency setting was a challenging environment in which to provide THN kits, although it may be possible to design a less restrictive protocol, for instance to allow administration to people accompanying patients during emergencies.