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Background  The aim of the study was to assess potential barriers and challenges to the implementation of take-home naloxone (THN) across ten prisons in one region of England.    Methods  Qualitative interviews deploying a grounded theory approach were utilised over a 12- to 18-month period that included an on-going structured dialogue with strategic and operational prison staff from the ten prisons and other key stakeholders ( n  = 17). Prisoner perceptions were addressed through four purposive focus groups belonging to different establishments ( n  = 26). Document analysis also included report minutes and access to management information and local performance reports. The data were thematically interpreted using visual mapping techniques.    Results  The distribution and implementation of THN in a prison setting was characterised by significant barriers and challenges. As a result, four main themes were identified: a wide range of negative and confused perceptions of THN amongst prison staff and prisoners; inherent difficulties with the identification and engagement of eligible prisoners; the need to focus on individual prison processes to enhance the effective distribution of THN; and the need for senior prison staff engagement.    Conclusions  The distribution of THN within a custodial setting requires consideration of a number of important factors which are discussed.

Stakeholder perceptions and operational barriers in the training and distribution of take-home naloxone within prisons in England