Overdose prevention training with naloxone distribution in a prison in Oslo, Norway: a preliminary study

Abstract

BackgroundPrison inmates face a ten times increased risk of experiencing a fatal drug overdose during their first 2 weeks upon release than their non-incarcerated counterparts. Naloxone, the antidote to an opioid overdose, has been shown to be feasible and effective when administered by bystanders. Given the particular risk that newly released inmates face, it is vital to assess their knowledge about opioid overdoses, as well as the impact of brief overdose prevention training conducted inside prisons.MethodsPrison inmates nearing release (within 6 months) in Oslo, Norway, voluntarily underwent a brief naloxone training. Using a questionnaire, inmates were assessed immediately prior to and following a naloxone training. Descriptive statistics were performed for main outcome variables, and the Wilcoxon signed-rank test was used to compare the participants’ two questionnaire scores from pre-and post-training.ResultsParticipating inmates (n = 31) were found to have a high baseline knowledge of risk factors, symptoms, and care regarding opioid overdoses. Nonetheless, a brief naloxone training session prior to release significantly improved knowledge scores in all areas assessed (p < 0.001). The training appears to be most beneficial in improving knowledge regarding the naloxone, including its use, effect, administration, and aftercare procedures.ConclusionsGiven the high risk of overdosing that prison inmates face upon release, the need for prevention programs is critical. Naloxone training in the prison setting may be an effective means of improving opioid overdose response knowledge for this particularly vulnerable group. Naloxone training provided in the prison setting may improve the ability of inmates to recognize and manage opioid overdoses after their release; however, further studies on a larger scale are needed.

A conceptual model for understanding post-release opioid-related overdose risk

“…Large-scale distribution of naloxone to individuals being released from prison is feasible and acceptable [145]. Naloxone training appears to be effective in increasing incarcerated individuals’ knowledge about naloxone and its use [146]. In New York, a pilot program trained 700 people in prison to administer naloxone to reverse opioid-related overdose, but only 200 received take-home naloxone kits at the time of release [147].…”

A scoping review of factors that influence opioid overdose prevention for justice-involved populations

“…As currently conceived, the Good Samaritan law does not provide immunity for individuals who inject drugs and are already enmeshed in the CJS, or are fearful of losing their housing. Petterson & Madah-Amiri, 2017 [ 21 ] To assess knowledge of opioid OD among inmates at risk of witnessing or experiencing an OD before and after a brief training session about naloxone prior to re-entry Pre/post training intervention survey 31 current or former opioid-using offenders within 6 months of release from incarceration in Oslo, Norway; half of the participants were receiving methadone treatment prior to prison; 100% male • Nearly every participant reported that they previously had witnessed an overdose and almost half had experienced between 1 and 10 personally. • Participating inmates were found to have a high baseline knowledge of risk factors, symptoms and care regarding opioid overdoses on an Opioid Overdose Knowledge Scale • A brief naloxone training session on how to recognize and respond to an opioid overdose with naloxone and how to assemble and use the device, significantly improved knowledge regarding naloxone use, effect, administration, and aftercare procedures.…”

“…Moreover, over the course of the study, there were 28 reported uses of naloxone, resulting in 27 recoveries and one fatality. Another study sampled 31 men with an OUD history who were within 6 months of release from prison in Norway [ 21 ]. Nearly all participants reported they had previously witnessed an overdose, and about half had personally overdosed, ranging from one to 10 times.…”

Fentanyl-related overdose during incarceration: a comprehensive review

“…As a harm reduction measure, naloxone trainings should be widely available to all staff and individuals who are incarcerated. Studies of naloxone training in the correctional setting underscore the potential for individuals who are incarcerated to participate in trainings and correctly administer intranasal naloxone while incarcerated (Green, Ray, Bowman, McKenzie, & Rich, 2014 ; Kobayashi et al, 2017 ; Parmar, Strang, Choo, Meade, & Bird, 2017 ; Petterson & Madah-Amiri, 2017 ). At a minimum, naloxone should be present in all correctional units, and units should be staffed with correctional officers who are trained in naloxone administration.…”