Naloxone in Correctional Facilities for the Prevention of Opioid Overdose Deaths

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Introduction

Drug overdose, primarily from opioids, was the leading cause of injury death in the United States in 2017.1 Drug/alcohol overdose is the third leading cause of death in jails and prisons, following illness and suicide.2,3 Furthermore, the risk of death from opioid overdose is high after release from prison or jail.4

Opioid overdose results in death from coma and cessation of breathing. Opioid overdose is reversible through the immediate administration of a quick-acting opioid antagonist called naloxone (Narcan®) that blocks the action of the opioid, e.g., heroin or prescription opioids. Its administration typically results in return to consciousness, resumption of breathing, and, in cases of opioid dependence, onset of opioid withdrawal symptoms.

Naloxone is safe, effective, and nonaddictive and has a rapid onset of action. It can be administered as an injection or through the nose (intranasally). Training in its administration is relatively simple. It can be safely used by nonmedical personnel, resulting in more lives saved.

To date, 46 states and the District of Columbia have enacted laws related to use of naloxone to treat opioid overdose.5 Nearly all states permit pharmacies to provide naloxone to anyone who wants it without a prescription. Importantly, all states have authorized its use by first responders, e.g., paramedics. States have developed training and educational materials to ensure naloxone is appropriately administered and the person who has overdosed is safely transported to an emergency facility.6 Simple administration procedures are available.7

Given this widespread need for and acceptance of easy access to naloxone, correctional facilities can play an important role in preventing overdose deaths. Research has shown that opioid overdose education and naloxone distribution programs in prisons and jails reduce mortality.8,9,10 At least five states have jails and prisons that have implemented overdose education and naloxone distribution programs, including providing naloxone kits to high-risk individuals at the time of release.

The American Society of Addiction Medicine supports broadened accessibility to naloxone for individuals commonly in a position to initiate early response to suspected opioid overdose, specifically for correctional officers.11

Position Statement

The National Commission on Correctional Health Care supports increased access to and use of naloxone in correctional facilities.

NCCHC recommends that all facilities make naloxone kits readily available and that custody and health staff undergo training that includes education regarding opioid overdose and its signs; correct technique for administration of naloxone; and essential related procedures, including performance of cardiopulmonary resuscitation and emergency transfer of the incarcerated patient to a facility equipped to treat overdose.

NCCHC supports efforts to educate incarcerated individuals about overdose and naloxone use, and to provide naloxone kits at release to those with diagnosed opioid use disorder as well as those at particularly high risk of overdose.

NCCHC also supports efforts to educate the family and loved ones of incarcerated individuals and to provide naloxone kits to visitors.12

April 12, 2015 – adopted by the National Commission on Correctional Health Care Board of Directors
November 1, 2020 – reaffirmed with revision

 

Resources

A Primer for Implementation of Overdose Education and Naloxone Distribution in Jails and Prisons. RTI International, 2019. https://www.thenationalcouncil.org/wp-content/uploads/2020/01/Naloxone-Prison-Primer_v2.pdf

Relevant NCCHC standards from the Standards for Health Services (2018) for jails and prisons:
• C-04 Health Training for Correctional Officers
• D-01 Pharmaceutical Operations

References

1. Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2018, December). Drug and opioid-involved overdose deaths – United States, 2013-2017. Morbidity and Mortality Weekly Report, 67(5152), 1419-1427. https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm?s_cid=mm675152e1_w

2. Carson, E. A., & Cowhig, M. P. (2020, February). Mortality in local jails, 2000-2016 – statistical tables (NCJ 251921). https://www.bjs.gov/content/pub/pdf/mlj0016st.pdf

3. Carson, E. A., & Cowhig, M. P. (2020, February). Mortality in state and federal prisons, 2001-2016 –  statistical tables (NCJ 251920). https://www.bjs.gov/content/pub/pdf/msfp0116st.pdf

4. Binswanger, I. A., Blatchford, P. J., Mueller, S. R., & Stern, M. F. (2013). Mortality after prison release: Opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009. Annals of Internal Medicine, 159, 592-600. doi: 10.7326/0003-4819-159-9-201311050-00005

5. Vestal, C. (2019, May 1). New naloxone laws seek to prevent opioid overdoses. PEW Stateline. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2019/05/01/new-naloxone-laws-seek-to-prevent-opioid-overdoses

6. National Institute on Drug Abuse. (2018, June). Medications to treat opioid use disorder: Is naloxone accessible? https://www.drugabuse.gov/publications/medications-to-treat-opioid-addiction/naloxone-accessible

7. Harm Reduction Coalition. (n.d.) Administer naloxone. https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/administer-naloxone/

8. Bennett, T. H., & Holloway, K. (2012). The impact of take-home naloxone distribution and training on opiate overdose knowledge and response: An evaluation of the THN Project in Wales. Drugs: Education, Prevention and Policy, 19, 320-328. doi: 10.3109/09687637.2012.658104

9. Bird, S. M., McAuley, A., Perry, S., & Hunter, C. (2016). Effectiveness of Scotland's national naloxone programme for reducing opioid-related deaths: A before (2006-10) versus after (2011-13) comparison. Addiction, 111, 883-891. doi: 10.1111/add.13265

10. Horsburgh, K., & McAuley, A. (2018). Scotland’s national naloxone program: The prison experience. Drug and Alcohol Review, 37, 454-456. doi: 10.1111/dar.12542

11. American Society of Addiction Medicine. (rev. 2016, October). Public Policy Statement on the Use of Naloxone for the Prevention of Drug Overdose Deaths. https://www.asam.org/docs/default-source/public-policy-statements/use-of-naloxone-for-the-prevention-of-opioid-overdose-deaths-final.pdf

12. Huxley-Reicher, Z., Maldjian, L., Winkelstein, E., Siegler, A., Paone, D., Tuazon, E., Nolan M.L., Jordan, A. O., MacDonald R., & Junins, H.V. (2017). Witnessed overdoses and naloxone use among visitors to Rikers Island jails trained in overdose rescue. Journal of Addictive Behaviors, 86, 73-78. https://www.sciencedirect.com/science/article/abs/pii/S0306460317304379