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Jail-Based Overdose Education and Naloxone Distribution Reaches Previously Unengaged, High-Risk Populations

Study of San Francisco County Jail program shows impact and offers insights for effective implementation


RESEARCH TRIANGLE PARK, N.C. — Incarcerated people have a 129 times higher risk of dying from an overdose during the first two weeks after their release than the general public. A recent study on Overdose Education and Naloxone Distribution (OEND) programs implemented in a San Francisco jail found that its OEND program was able to effectively reach this largely inaccessible, high-risk population with life-saving training.


The study, led by RTI International Distinguished Fellow, Alex H. Kral, PhD, was recently published in the Journal of Correctional Health Care and catalogues the success of directly engaging incarcerated people who use drugs prior to their release to prevent overdose fatality upon reentry. The evaluation was a collaboration among scientists at the San Francisco Department of Public Health, the Harm Reduction Coalition, University of California’s Berkeley and San Diego campuses, and Kaiser Permanente Colorado.

Between March 2013 and April 2017, the San Francisco jail OEND program had 637 participants, 67 percent of whom opted to receive naloxone kits after completing the training. Of those who chose to receive a kit, 25 percent had experienced an opioid overdose and 63 percent reported having witnessed an overdose at least once prior to their incarceration. In addition, when asked why they wanted to attend the training, 87 percent of attendees stated that a partner, friends, neighbors, or people in their community were at risk of overdose. This shows that OEND programs in jails offer an additional benefit beyond targeting a high-risk population on the individual level: they also result in extended community benefits by engaging those who are (a) members of high-risk communities and (b) willing and able to assist others within those communities.

“Ninety-seven percent of jail OEND program participants had not been previously trained on how to treat an opioid overdose and minimize overdose risks,” said Dr. Kral. “This study shows that OEND programs in jails are an efficient way to reach a high-risk, previously unengaged population.”

The ongoing jail OEND program is a collaboration among the San Francisco Department of Public Health, San Francisco Jail Health Services, the Harm Reduction Coalition and the San Francisco Sheriff’s Department. The training, which consists of a 19-minute overdose prevention video, reviews overdose risks, ways to reduce those risks, and how to respond in the event of an overdose. Higher-risk individuals — those who reported opioid use prior to incarceration—receive one-on-one OEND training in a private setting. If the participants elect to receive naloxone after their training, the overdose antidote is then placed in their property upon their release from jail.

The study found that among the OEND trainees who received naloxone from the program, 44 percent subsequently accessed syringe services programs in the community to receive naloxone refills. Many participants went on to teach others about minimizing overdose risks, and 32 percent of OEND participants seeking a naloxone refill reported using their naloxone to reverse an overdose. Taking on these new prosocial roles upon their release improved participants’ feelings of confidence, satisfaction, and self-worth, while also helping to combat negative stereotypes against incarcerated populations and people who use drugs.

Based on the belief that rehabilitation through education is more effective and humane than threatening further punishment, a few countries around the world and five U.S. states have begun implementing OEND programs in jail and prison settings to varying degrees. To further promote and support OEND programs in the unique features of jails and prisons, the authors of this study also created a primer to help implement OEND programs and prevent opioid-related overdose deaths among people who have contact with jails and prisons.

To learn more about how to implement a jail-based OEND program, view the primer. For more information on this topic, read the blog post by Dr. Kral.