History of Naloxone Possession Among Rural and Urban Individuals Participating in Prison-Based Treatment: An Observational Study

Background: Individuals involved in the criminal-legal system, particularly those incarcerated in prisons, are highly impacted by the opioid epidemic. Individuals from rural areas who are incarcerated may face disparate access to naloxone, the agent used to reverse opioid-induced respiratory depression. This objective of this study was to describe pre-incarceration possession of naloxone among rural and urban individuals incarcerated in state prisons. Methods: As part of the Geographic variation in Addiction Treatment Experiences study, data were collected from adults incarcerated and released from 14 Kentucky state prisons. Eligible individuals had a history of opioid use disorder and had participated in prison-based substance use disorder treatment. Structured surveys were conducted from June 2021 to March 2024 (n = 393). Two dependent variables, lifetime and recent possession of naloxone in the 6 months prior to incarceration, were measured. Then, 2 multivariate logistic regression models were estimated to examine associations between rurality, demographic characteristics, and opioid-related measures on these 2 dependent variables. Results: About 56% of the sample had personally experienced opioid overdose. Prior to incarceration, 47% had ever possessed naloxone and 36% reported recent possession of naloxone. Rural individuals were significantly less likely than urban individuals to report lifetime naloxone possession (odds ratio [OR] = 0.58, 95% CI = 0.35-0.96, P = .04) and recent naloxone possession (OR = 0.56, 95% CI = 0.33-0.97, P = .04). Conclusions: In this sample recruited from Kentucky prisons, many individuals had experienced an overdose prior to incarceration, but few had naloxone. Given the significant disparities between rural and urban individuals in naloxone possession prior to incarceration, greater access to naloxone at prison release and in communities is urgently needed.