Objectives To describe the change in opioid-related deaths (ORDs) recorded across Scotland since National ‘Take Home’ Naloxone Programme (NNP) implementation between baseline pre-implementation (2006 – 2010) and 10-year post implementation (2011 – 2020) periods. To describe and contextualise the change in ORDs within 4 weeks of prison release and hospital discharge across the same pre- and post-implementation periods and evaluate the reach of naloxone to people at risk of opioid overdose during this period.

Methods Descriptive statistics as part of a pre-post secondary contribution analysis approach. The Better Evaluation Rainbow Framework for impact evaluation was utilised and data was obtained from official statistics and monitoring reports via Public Health Scotland.

Results An increase in total ORDs nationwide was observed post-NNP implementation. In 2006–10, 9·8 % of ORDs (193 of 1970) were in people released from prison within 4 weeks of death, whereas only 4·4 % of ORDs (281 of 6439) in 2011–20 followed prison release, representing a 55 % reduction. A similar reduction in ORDs following hospital discharge was not observed. Cumulative reach of take-home naloxone to individuals at risk of opioid overdose across the post-implementation period was 58 %.

Conclusions Implementation of the Scottish NNP has coincided with an increase in total ORDs nationwide, increased availability of take-home naloxone for management of opioid overdose and a reduction in the proportion of opioid-related fatalities among recently released prisoners. Unfortunately, the proportion ORDs after hospital discharge remain unchanged suggesting that this population may benefit from further research and additional distribution approaches.