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

Hannah K. Knudsen; Evan Batty; Michele Staton; Haily K. Traxler; Carrie B. Oser

doi:10.1177/29767342251401705

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

Hannah K. Knudsen
, Evan Batty
, Michele Staton
, Haily K. Traxler
, Carrie B. Oser

Producción científica: Article › revisión exhaustiva

Resumen

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.

Idioma original	English
Páginas (desde-hasta)	680-689
Número de páginas	10
Publicación	Substance Use and Addiction Journal
Volumen	47
N.º	3
DOI	https://doi.org/10.1177/29767342251401705
Estado	Published - jul 2026

Nota bibliográfica

Publisher Copyright:
© 2026 by AMERSA, Inc.

Financiación

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Drug Abuse (NIDA) under award number R01-DA48876. The contents of this publication are solely the responsibility of the authors and do not represent the official views of NIDA or the Kentucky Department of Corrections. We would like to thank the participants in the GATE study as well as the Kentucky Department of Corrections for their collaboration. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Drug Abuse (NIDA) under award number R01-DA48876. The contents of this publication are solely the responsibility of the authors and do not represent the official views of NIDA or the Kentucky Department of Corrections.

Financiadores

Número del financiador

Kentucky Department of Corrections

Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse

R01-DA48876

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

Good health and well being
Peace justice and strong institutions

ASJC Scopus subject areas

Medicine (miscellaneous)
Psychiatry and Mental health

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10.1177/29767342251401705

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@article{e8454e8e402a4ad89950fcf0864a248f,

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

abstract = "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.",

keywords = "health disparities, incarceration, naloxone, rural",

author = "Knudsen, \{Hannah K.\} and Evan Batty and Michele Staton and Traxler, \{Haily K.\} and Oser, \{Carrie B.\}",

note = "Publisher Copyright: {\textcopyright} 2026 by AMERSA, Inc.",

year = "2026",

month = jul,

doi = "10.1177/29767342251401705",

language = "English",

volume = "47",

pages = "680--689",

number = "3",

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TY - JOUR

T1 - History of Naloxone Possession Among Rural and Urban Individuals Participating in Prison-Based Treatment

T2 - An Observational Study

AU - Knudsen, Hannah K.

AU - Batty, Evan

AU - Staton, Michele

AU - Traxler, Haily K.

AU - Oser, Carrie B.

PY - 2026/7

Y1 - 2026/7

N2 - 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.

AB - 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.

KW - health disparities

KW - incarceration

KW - naloxone

KW - rural

UR - https://www.scopus.com/pages/publications/105026824062

UR - https://www.scopus.com/pages/publications/105026824062#tab=citedBy

U2 - 10.1177/29767342251401705

DO - 10.1177/29767342251401705

M3 - Article

AN - SCOPUS:105026824062

SN - 2976-7342

VL - 47

SP - 680

EP - 689

JO - Substance Use and Addiction Journal

JF - Substance Use and Addiction Journal

IS - 3

ER -

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

Resumen

Nota bibliográfica

Financiación

ODS de las Naciones Unidas

ASJC Scopus subject areas

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