Overdose education and naloxone distribution in jails: Examining the impact of the Communities That HEAL intervention in 4 states

Timothy Hunt; Carrie B. Oser; Peter D. Friedmann; Nicole Mack; Peter Balvanz; Bridget Freisthler; Redonna K. Chandler; Karli Hochstatter; Daniel R. Harris; La Shawn Glasgow; Lauren D’Costa; Mary R. Russo; Barry Eggleston; Arnie Aldridge; Paul Bellair; Allyson G. Cogan; James L. David; Nabila El-Bassel; Dawn Goddard-Eckrich; Steve Gomori; Holly Hagan; Steve Hanson; Ja Nae Holloway; Elizabeth N. Kinnard; Charlie Knott; Michael W. Konstan; Sharon L. Walsh; Patricia A. LeBaron; Michael S. Lyons; Margaret McGladrey; Joan Papp; Sean M. Murphy; Sandra Springer; Emmanuel Oga; Michele Staton; Elizabeth Schady; Fernando Montero; Hilary L. Surratt; Danelle Stevens-Watkins; John Winhusen; Gary A. Zarkin; Greer A. Hamilton; Joel G. Sprunger

doi:10.1186/s40352-025-00353-5

Overdose education and naloxone distribution in jails: Examining the impact of the Communities That HEAL intervention in 4 states

Timothy Hunt, Carrie B. Oser, Peter D. Friedmann, Nicole Mack, Peter Balvanz, Bridget Freisthler, Redonna K. Chandler, Karli Hochstatter, Daniel R. Harris, La Shawn Glasgow, Lauren D’Costa, Mary R. Russo, Barry Eggleston, Arnie Aldridge, Paul Bellair, Allyson G. Cogan, James L. David, Nabila El-Bassel, Dawn Goddard-Eckrich, Steve GomoriHolly Hagan, Steve Hanson, Ja Nae Holloway, Elizabeth N. Kinnard, Charlie Knott, Michael W. Konstan, Sharon L. Walsh, Patricia A. LeBaron, Michael S. Lyons, Margaret McGladrey, Joan Papp, Sean M. Murphy, Sandra Springer, Emmanuel Oga, Michele Staton, Elizabeth Schady, Fernando Montero, Hilary L. Surratt, Danelle Stevens-Watkins, John Winhusen, Gary A. Zarkin, Greer A. Hamilton, Joel G. Sprunger

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Opioid-related overdose is the leading cause of mortality among individuals recently released from incarceration in the U.S. Naloxone is an FDA-approved opioid antagonist medication designed to rapidly reverse opioid overdose. Despite evidence of its acceptability and effectiveness at reducing the risk of opioid overdose death after release from incarceration, only an estimated 25% of US jails provide naloxone upon release. This study examines the effectiveness of the HEALing Communities Study (HCS) Communities That HEAL (CTH) intervention on enhancing access to overdose education and naloxone distribution (OEND) in participating jails in Kentucky, New York, Massachusetts, and Ohio. Methods: Communities were randomized to intervention (n = 34) or wait-list control (n = 33) arms stratified by state. Jail-based surveys (n = 59) were implemented at three time points during 2019 to 2022. Generalized linear mixed models (GLMM) with imputation captured intervention effects during the evaluation period (July 1, 2021-June 30, 2022). Interpretation of results was informed by the Practical, Robust Implementation and Sustainability Model framework. Results: The CTH intervention was significantly associated with the hypothesized outcome, resulting in a greater number of jails providing overdose education (H1, relative risk_Adj = 1.51 [95% CI: 1.09, 2.08], p = 0.013) and the number of jails providing naloxone upon release (H2, relative risk_Adj = 1.49 [95% CI: 1.05, 2.13)], p = 0.027). External factors related to OEND implementation, such as correctional health care models, available resources, and state COVID restrictions, varied across communities. Conclusions: The CTH intervention engaging community coalitions to deploy evidence-based practices was effective in increasing OEND implementation in jails, helping address elevated overdose risks for individuals during and post-release from incarceration. Partnerships between state, community, and jail-based stakeholders are needed to assure expanded access to this lifesaving, evidence-based approach.

Original language	English
Article number	47
Journal	Health and Justice
Volume	13
Issue number	1
DOIs	https://doi.org/10.1186/s40352-025-00353-5
State	Published - Dec 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2025.

Funding

This research was supported by the National Institutes of Health and the Substance Abuse and Mental Health Services Administration through the NIH HEAL (Helping to End Addiction Long-term®) Initiative under award numbers UM1DA049394, UM1DA049406, UM1DA049412, UM1DA049415, UM1DA049417 (ClinicalTrials.gov Identifier: NCT04111939). This research was supported by the National Institutes of Health and the Substance Abuse and Mental Health Services Administration through the NIH HEAL (Helping to End Addiction Long-term) Initiative under award numbers UM1DA049394, UM1DA049406, UM1DA049412, UM1DA049415, UM1DA049417 (ClinicalTrials.gov Identifier: NCT04111939).

Funders	Funder number
Substance Abuse and Mental Health Services Administration
National Institutes of Health (NIH)	UM1DA049412, UM1DA049394, UM1DA049415, NCT04111939, UM1DA049406, UM1DA049417

Keywords

Carceral settings
Jail
Naloxone distribution
Opioid epidemic
Overdose education

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health
Law

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s40352-025-00353-5

Cite this

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

@article{51b0d9fa095b4644acea5f6b1c76e04c,

title = "Overdose education and naloxone distribution in jails: Examining the impact of the Communities That HEAL intervention in 4 states",

abstract = "Background: Opioid-related overdose is the leading cause of mortality among individuals recently released from incarceration in the U.S. Naloxone is an FDA-approved opioid antagonist medication designed to rapidly reverse opioid overdose. Despite evidence of its acceptability and effectiveness at reducing the risk of opioid overdose death after release from incarceration, only an estimated 25\% of US jails provide naloxone upon release. This study examines the effectiveness of the HEALing Communities Study (HCS) Communities That HEAL (CTH) intervention on enhancing access to overdose education and naloxone distribution (OEND) in participating jails in Kentucky, New York, Massachusetts, and Ohio. Methods: Communities were randomized to intervention (n = 34) or wait-list control (n = 33) arms stratified by state. Jail-based surveys (n = 59) were implemented at three time points during 2019 to 2022. Generalized linear mixed models (GLMM) with imputation captured intervention effects during the evaluation period (July 1, 2021-June 30, 2022). Interpretation of results was informed by the Practical, Robust Implementation and Sustainability Model framework. Results: The CTH intervention was significantly associated with the hypothesized outcome, resulting in a greater number of jails providing overdose education (H1, relative riskAdj = 1.51 [95\% CI: 1.09, 2.08], p = 0.013) and the number of jails providing naloxone upon release (H2, relative riskAdj = 1.49 [95\% CI: 1.05, 2.13)], p = 0.027). External factors related to OEND implementation, such as correctional health care models, available resources, and state COVID restrictions, varied across communities. Conclusions: The CTH intervention engaging community coalitions to deploy evidence-based practices was effective in increasing OEND implementation in jails, helping address elevated overdose risks for individuals during and post-release from incarceration. Partnerships between state, community, and jail-based stakeholders are needed to assure expanded access to this lifesaving, evidence-based approach.",

keywords = "Carceral settings, Jail, Naloxone distribution, Opioid epidemic, Overdose education",

author = "Timothy Hunt and Oser, \{Carrie B.\} and Friedmann, \{Peter D.\} and Nicole Mack and Peter Balvanz and Bridget Freisthler and Chandler, \{Redonna K.\} and Karli Hochstatter and Harris, \{Daniel R.\} and Glasgow, \{La Shawn\} and Lauren D{\textquoteright}Costa and Russo, \{Mary R.\} and Barry Eggleston and Arnie Aldridge and Paul Bellair and Cogan, \{Allyson G.\} and David, \{James L.\} and Nabila El-Bassel and Dawn Goddard-Eckrich and Steve Gomori and Holly Hagan and Steve Hanson and Holloway, \{Ja Nae\} and Kinnard, \{Elizabeth N.\} and Charlie Knott and Konstan, \{Michael W.\} and Walsh, \{Sharon L.\} and LeBaron, \{Patricia A.\} and Lyons, \{Michael S.\} and Margaret McGladrey and Joan Papp and Murphy, \{Sean M.\} and Sandra Springer and Emmanuel Oga and Michele Staton and Elizabeth Schady and Fernando Montero and Surratt, \{Hilary L.\} and Danelle Stevens-Watkins and John Winhusen and Zarkin, \{Gary A.\} and Hamilton, \{Greer A.\} and Sprunger, \{Joel G.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = dec,

doi = "10.1186/s40352-025-00353-5",

language = "English",

volume = "13",

number = "1",

}

Hunt, T, Oser, CB, Friedmann, PD, Mack, N, Balvanz, P, Freisthler, B, Chandler, RK, Hochstatter, K, Harris, DR, Glasgow, LS, D’Costa, L, Russo, MR, Eggleston, B, Aldridge, A, Bellair, P, Cogan, AG, David, JL, El-Bassel, N, Goddard-Eckrich, D, Gomori, S, Hagan, H, Hanson, S, Holloway, JN, Kinnard, EN, Knott, C, Konstan, MW, Walsh, SL, LeBaron, PA, Lyons, MS, McGladrey, M, Papp, J, Murphy, SM, Springer, S, Oga, E, Staton, M, Schady, E, Montero, F, Surratt, HL , Stevens-Watkins, D, Winhusen, J, Zarkin, GA, Hamilton, GA & Sprunger, JG 2025, 'Overdose education and naloxone distribution in jails: Examining the impact of the Communities That HEAL intervention in 4 states', Health and Justice, vol. 13, no. 1, 47. https://doi.org/10.1186/s40352-025-00353-5

TY - JOUR

T1 - Overdose education and naloxone distribution in jails

T2 - Examining the impact of the Communities That HEAL intervention in 4 states

AU - Hunt, Timothy

AU - Oser, Carrie B.

AU - Friedmann, Peter D.

AU - Mack, Nicole

AU - Balvanz, Peter

AU - Freisthler, Bridget

AU - Chandler, Redonna K.

AU - Hochstatter, Karli

AU - Harris, Daniel R.

AU - Glasgow, La Shawn

AU - D’Costa, Lauren

AU - Russo, Mary R.

AU - Eggleston, Barry

AU - Aldridge, Arnie

AU - Bellair, Paul

AU - Cogan, Allyson G.

AU - David, James L.

AU - El-Bassel, Nabila

AU - Goddard-Eckrich, Dawn

AU - Gomori, Steve

AU - Hagan, Holly

AU - Hanson, Steve

AU - Holloway, Ja Nae

AU - Kinnard, Elizabeth N.

AU - Knott, Charlie

AU - Konstan, Michael W.

AU - Walsh, Sharon L.

AU - LeBaron, Patricia A.

AU - Lyons, Michael S.

AU - McGladrey, Margaret

AU - Papp, Joan

AU - Murphy, Sean M.

AU - Springer, Sandra

AU - Oga, Emmanuel

AU - Staton, Michele

AU - Schady, Elizabeth

AU - Montero, Fernando

AU - Surratt, Hilary L.

AU - Stevens-Watkins, Danelle

AU - Winhusen, John

AU - Zarkin, Gary A.

AU - Hamilton, Greer A.

AU - Sprunger, Joel G.

PY - 2025/12

Y1 - 2025/12

N2 - Background: Opioid-related overdose is the leading cause of mortality among individuals recently released from incarceration in the U.S. Naloxone is an FDA-approved opioid antagonist medication designed to rapidly reverse opioid overdose. Despite evidence of its acceptability and effectiveness at reducing the risk of opioid overdose death after release from incarceration, only an estimated 25% of US jails provide naloxone upon release. This study examines the effectiveness of the HEALing Communities Study (HCS) Communities That HEAL (CTH) intervention on enhancing access to overdose education and naloxone distribution (OEND) in participating jails in Kentucky, New York, Massachusetts, and Ohio. Methods: Communities were randomized to intervention (n = 34) or wait-list control (n = 33) arms stratified by state. Jail-based surveys (n = 59) were implemented at three time points during 2019 to 2022. Generalized linear mixed models (GLMM) with imputation captured intervention effects during the evaluation period (July 1, 2021-June 30, 2022). Interpretation of results was informed by the Practical, Robust Implementation and Sustainability Model framework. Results: The CTH intervention was significantly associated with the hypothesized outcome, resulting in a greater number of jails providing overdose education (H1, relative riskAdj = 1.51 [95% CI: 1.09, 2.08], p = 0.013) and the number of jails providing naloxone upon release (H2, relative riskAdj = 1.49 [95% CI: 1.05, 2.13)], p = 0.027). External factors related to OEND implementation, such as correctional health care models, available resources, and state COVID restrictions, varied across communities. Conclusions: The CTH intervention engaging community coalitions to deploy evidence-based practices was effective in increasing OEND implementation in jails, helping address elevated overdose risks for individuals during and post-release from incarceration. Partnerships between state, community, and jail-based stakeholders are needed to assure expanded access to this lifesaving, evidence-based approach.

AB - Background: Opioid-related overdose is the leading cause of mortality among individuals recently released from incarceration in the U.S. Naloxone is an FDA-approved opioid antagonist medication designed to rapidly reverse opioid overdose. Despite evidence of its acceptability and effectiveness at reducing the risk of opioid overdose death after release from incarceration, only an estimated 25% of US jails provide naloxone upon release. This study examines the effectiveness of the HEALing Communities Study (HCS) Communities That HEAL (CTH) intervention on enhancing access to overdose education and naloxone distribution (OEND) in participating jails in Kentucky, New York, Massachusetts, and Ohio. Methods: Communities were randomized to intervention (n = 34) or wait-list control (n = 33) arms stratified by state. Jail-based surveys (n = 59) were implemented at three time points during 2019 to 2022. Generalized linear mixed models (GLMM) with imputation captured intervention effects during the evaluation period (July 1, 2021-June 30, 2022). Interpretation of results was informed by the Practical, Robust Implementation and Sustainability Model framework. Results: The CTH intervention was significantly associated with the hypothesized outcome, resulting in a greater number of jails providing overdose education (H1, relative riskAdj = 1.51 [95% CI: 1.09, 2.08], p = 0.013) and the number of jails providing naloxone upon release (H2, relative riskAdj = 1.49 [95% CI: 1.05, 2.13)], p = 0.027). External factors related to OEND implementation, such as correctional health care models, available resources, and state COVID restrictions, varied across communities. Conclusions: The CTH intervention engaging community coalitions to deploy evidence-based practices was effective in increasing OEND implementation in jails, helping address elevated overdose risks for individuals during and post-release from incarceration. Partnerships between state, community, and jail-based stakeholders are needed to assure expanded access to this lifesaving, evidence-based approach.

KW - Carceral settings

KW - Jail

KW - Naloxone distribution

KW - Opioid epidemic

KW - Overdose education

UR - https://www.scopus.com/pages/publications/105011756007

UR - https://www.scopus.com/inward/citedby.url?scp=105011756007&partnerID=8YFLogxK

U2 - 10.1186/s40352-025-00353-5

DO - 10.1186/s40352-025-00353-5

M3 - Article

AN - SCOPUS:105011756007

SN - 2194-7899

VL - 13

JO - Health and Justice

JF - Health and Justice

IS - 1

M1 - 47

ER -

Overdose education and naloxone distribution in jails: Examining the impact of the Communities That HEAL intervention in 4 states

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this