Study Shows Community Coalition-Prioritized Strategies Increased Naloxone Education and Distribution in Jails

Addiction Policy Forum
5 days ago
5 min read

Recent findings published in Health & Justice show that the NIH HEALing Communities Study (HCS) was associated with a significant increase in the number of jails that provided overdose education and delivery of naloxone to individuals returning from incarceration in participating communities. These results underscore the value of a community-engaged intervention that leveraged local coalitions to plan and implement overdose education and naloxone distribution (OEND) strategies to expand access to life-saving overdose prevention services within correctional settings.

“This study is the first to evaluate a community-engaged intervention that uses local coalitions to drive action planning for implementation of OEND in jails to address opioid overdose among people impacted by incarceration,” says lead author Dr. Timothy Hunt, Research Scientist and Associate Director of the Social Intervention Group at the Columbia University School of Social Work.

The transition from incarceration back to the community is a high-risk and vulnerable period, especially for individuals with a substance use disorder (SUD). Research has shown that overdoses are one of the leading causes of death for individuals returning to the community following incarceration (Hunt et al., 2025), and individuals are up to 129 times more likely to die from an overdose within the first two weeks compared to the general population (Binswanger et al., 2007). Yet, only about 25% (or one in four) U.S. jails currently provide naloxone to individuals upon release (Maruschak et al., 2023; Scott et al., 2022).

OEND initiatives have been shown to be effective in reducing overdose fatalities in both community and justice settings. These programs provide naloxone to individuals at risk of overdose (or likely to witness one) and educate them on how to recognize and respond to an overdose. OEND programs have also been effective in promoting community confidence and willingness to intervene in overdose situations (Hunt et al., 2025).

Launched in 2019, the HCS is the largest addiction prevention and treatment implementation study ever conducted that tested the impact of a community-driven approach—called Communities That HEAL intervention—designed to empower local coalitions and help them select and implement effective strategies and practices best suited to their needs. Through its efforts, the HCS helped 67 communities across four states (New York, Massachusetts, Kentucky, and Ohio) overcome barriers to scaling up evidence-based strategies, including OENDs, medications for opioid use disorder (MOUD), and safer opioid prescribing and dispensing practices across a variety of settings to reduce opioid-related deaths.

Sheriff Juan Figueroa of Ulster County, New York, which was one of the participating HCS communities, shares: “As the epidemic continues, being alert and saving the lives of those who suffer from substance use disorders remains a priority in Ulster County. Our partnership with the county government, our community, and the HEAL intervention assures law enforcement, families, and community partners collaborate to educate those at risk of overdoses through education and knowledge in the use of Naloxone.”

In this study, researchers assessed the impact of the Communities That HEAL intervention, which supported local coalitions in planning and implementing OEND strategies to address overdose risk among individuals impacted by incarceration. Jail-based OEND outcomes were measured through surveys administered to HCS Intervention communities (n = 34) that received the intervention first and implemented strategies between January 1, 2020, and June 30, 2022. These results were compared to HCS Waitlist control communities (n = 33), which did not implement strategies until after Intervention communities concluded. Data were collected from all 67 participating communities between 2019 and 2022 at three points: baseline and two annual follow-ups.

Key Findings

HCS significantly increased both overdose education and naloxone delivery among participating jails:
- Overdose education: The number of Intervention community jails that provided overdose education increased from 38% at baseline to 77% after receiving HCS support. In comparison, 36% of the Waitlist control community jails provided overdose education at baseline.
- Naloxone distribution: Intervention community jails that distributed naloxone at release increased from 26% at baseline to 71% during the evaluation period; 36% of the Waitlist control community jails provided naloxone at release at baseline.

Flexible implementation models enabled success, with communities using a variety of approaches based on capacity and constraints:
- Education strategies: Jails used various methods to provide naloxone education (e.g., through tablets, kiosks, or facility communications devices), which allowed streamlined completion tracking and easy identification of who should receive naloxone. In addition, some jails played educational videos in booking areas where individuals were held while waiting to be processed into the facility.
- Naloxone was distributed at various points: Some jails provided naloxone upon release, while others offered naloxone at intake and placed it in personal belongings. Access methods included discharge kits, from vending machines in release areas, or through vouchers redeemable at community-based organizations or pharmacies.
- Targeted vs. Universal Approaches: Some jails offered OEND to all individuals leaving jail, while others focused on high-risk groups, such as individuals with SUDs.

"This study highlights the ingenuity of community-engaged collaborations between coalitions and correctional facilities to address a shared recognition that the post-release period is a dangerous one for overdoses among persons recently released from jail,” says senior author Dr. Joel Sprunger, Assistant Professor of Clinical Psychiatry and Behavioral Neuroscience at the University of Cincinnati College of Medicine. “Through many permutations of OEND across states and communities, these jails implemented strategies that undoubtedly saved lives."

“These findings underscore the success of the Communities That HEAL intervention in increasing both naloxone delivery and overdose education and the value of engaging local coalitions to work with correctional facilities and integrate OEND into correctional health services,” says Dr. Hunt. “By empowering communities, aligning with evidence-based practices, and leveraging flexible models of care, this community-engaged approach can save lives at one of the most dangerous transition points for individuals with SUD."

The Article

Hunt, T., Oser, C. B., Friedmann, P. D., Mack, N., Balvanz, P., Freisthler, B., Chandler, R. K., Hochstatter, K., Harris, D. R., Glasgow, L., D'Costa, L., Russo, M. R., Eggleston, B., Aldridge, A., Bellair, P., Cogan, A. G., David, J. L., El-Bassel, N., Goddard-Eckrich, D., Gomori, S., … Sprunger, J. G. (2025). Overdose education and naloxone distribution in jails: Examining the impact of the Communities That HEAL intervention in 4 states. Health & justice, 13(1), 47. https://doi.org/10.1186/s40352-025-00353-5

References

Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison--a high risk of death for former inmates. The New England journal of medicine, 356(2), 157–165. https://doi.org/10.1056/NEJMsa064115

Maruschak, L. M., Minton, T. D., & Zeng, Z. (2023). Opioid Use Disorder Screening and Treatment in Local Jails, 2019. https://bjs.ojp.gov/document/oudstlj19.pdf

Scott, C. K., Grella, C. E., Dennis, M. L., Carnevale, J., & LaVallee, R. (2022). Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S. Health & justice, 10(1), 36. https://doi.org/10.1186/s40352-022-00197-3