Naloxone Distribution in Treatment Centers and Criminal Justice Settings

Why this strategy works

Individuals with a history of incarceration are, in general, at higher risk overdose. Periods immediately following release from supervision or treatment, when a person's opioid tolerance is low, are especially dangerous: an individual is more than twenty-five-times more likely to overdose in the first weeks following the cessation of treatment than during treatment, and release from incarceration, also defined by abrupt reintegration in the context of lowered opioid tolerance, places individuals with opioid dependency at similar risk. Naloxone distribution programs operated within treatment and correctional setting are an effective way to train and equip this extremely high-risk group-as well as their friends and family members-with life-saving naloxone.  

Naloxone distribution in treatment centers and criminal justice settings works best when: 

• Coverage of these distribution programs is universal, providing all individuals leaving criminal justice setting or treatment with the opportunity to be trained and receive a naloxone kit. This is preferable to opt-in programs that require inmates to request special services to receive naloxone.
• Training is provided in a way that refrains from making negative judgments about drug use and focuses instead on the importance of every person's safety and wellbeing even in the context of drug use.
• Close contacts of the individual (family, partners, and children) are also trained in naloxone administration and overdose response.
• Naloxone distribution in treatment centers criminal justice settings works best when there is certainty in the supply chain and in funding. In treatment settings, an individual's insurance can cover the cost of naloxone.

• A nationwide study of more than 10,000 individuals exiting specialized drug treatment settings in the U.S. found that rates of overdose death were twenty-six times higher in the first death were twenty-six times higher in the first month following the cessation of treatment compared to the rate of overdose death while individuals were in treatment.
• A similar study of more than 5,000 individuals ceasing outpatient MAT for substance use disorder found that overdose death rates were nine times higher than baseline in the first two weeks following treatment cessation, eight times higher in weeks three and four following treatment cessation, and approximately 1.9 times higher in the second month.
• A large meta-analysis of data from several different nations found that individuals released from incarceration experience a three to eightfold increase in the rate of overdose death in the first two weeks after release compared to weeks three through twelve following release.

• A study carried out by the Massachusetts Department of Public Health found that individuals recently released from incarceration in the Commonwealth are 56 times more likely to overdose than members of the general public, indicating urgent need to scale up overdose prevention services for this population both before and after release.
• Scotland's National Naloxone Programme, which started providing naloxone at release to inmates in 2011, was associated with a 36% reduction in the proportion of opioid-related deaths that occurred within the first four weeks following an individual's release from prison.