Rapid jail-based implementation of overdose education and naloxone distribution in response to the COVID-19 pandemic

Carrie B Oser; Margaret McGladrey; Marisa Booty; Hilary Surratt; Hannah K Knudsen; Patricia R Freeman; Danelle Stevens-Watkins; Monica F Roberts; Michele Staton; April Young; Emma Draper; Sharon L Walsh

doi:10.1186/s40352-024-00283-8

Rapid jail-based implementation of overdose education and naloxone distribution in response to the COVID-19 pandemic

Health Justice. 2024 Jun 27;12(1):27. doi: 10.1186/s40352-024-00283-8.

Authors

Affiliations

¹ Department of Sociology, Center for Health Equity Transformation, Center on Drug & Alcohol Research, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY, 40506, USA. carrie.oser@uky.edu.
² Department of Health Management and Policy, Center for Innovation in Population Health, University of Kentucky, 111 Washington Avenue, Lexington, KY, 40508, USA.
³ Department of Sociology, University of Kentucky, 1515 Patterson Office Tower, Lexington, KY, 40506, USA.
⁴ Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA.
⁵ Department of Pharmacy Practice & Science, Center for the Advance of Pharmacy Practice, University of Kentucky, 789 S. Limestone, Lexington, KY 40508, USA.
⁶ Department of Educational, School, and Counseling Psychology, Center on Drug & Alcohol Research, University of Kentucky, 103 Dickey Hall, Lexington, KY 40506, USA.
⁷ Substance Use Priority Research Area, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA.
⁸ Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, 1100 Veterans Drive, Medical Behavioral Science Building, Lexington, KY, 40536, USA.
⁹ Department of Epidemiology and Environmental Health, Center on Drug & Alcohol Research, University of Kentucky, 111 Washington Ave, Lexington, KY 40508, USA.
¹⁰ Department of Psychology, Williams College, 25 Stetson Ct., Williamstown, MA, 01267, USA.

Abstract

Background: People incarcerated in jails are highly impacted by the opioid epidemic, and overdose education and naloxone distribution (OEND) is an effective strategy to reduce opioid overdose deaths. This study examines barriers and facilitators of fast-track OEND implementation within the jails in the Wave 1 Kentucky counties of the HEALing Communities Study during the COVID-19 pandemic.

Methods: Meeting minutes with jail stakeholders were qualitatively coded using the Practical, Robust Implementation and Sustainability Model (PRISM) as the coding framework. The analysis highlighted the top barriers and facilitators to fast-track OEND implementation within the PRISM framework.

Results: Space and staffing shortages related to the COVID-19 pandemic, disruptions in interorganizational programming from pandemic-related service suspensions, and a lack of technological solutions (e.g., reliable Internet access) for socially distanced delivery were the top barriers to fast-track OEND implementation. In addition, there were limitations on non-jail staff access to jails during COVID-19. Top facilitators included jail leadership support, the option to prioritize high-risk groups, and the incorporation of OEND processes into existing communications and management software. While the COVID-19 pandemic strained jail infrastructure, jail and partner agency collaboration led to creative implementation strategies for the successful integration of OEND into jail operations. Urban jails were more likely than rural jails to be early adopters of OEND during the public health emergency.

Conclusions: Understanding the barriers to and facilitators of OEND within jails will improve implementation efforts seeking to curb opioid overdose deaths. Jail leadership support and interorganizational efforts were key facilitators to implementation; therefore, it is recommended to increase buy-in with multiple agencies to promote success. Challenges brought on by COVID-19 have resulted in a need for innovative solutions for implementation.

Clinical trial information: ClinicalTrials.gov, NCT04111939, Submitted 30 September 2019, https://clinicaltrials.gov/study/NCT04111939?titles=HEALing%20Communities%20Study&rank=1 .

Keywords: COVID-19 pandemic; Implementation science; Jails; Naloxone; Practical, robust implementation and sustainability model (PRISM).

Associated data

ClinicalTrials.gov/NCT04111939

Abstract

Associated data

Grants and funding