Criminal Legal System

Naloxone can help prevent overdose deaths for people involved in the criminal legal system. The medication can be distributed to people directly or be available onsite to prevent an overdose death in jail, prison, drug court, or a probation or parole office.

People who use opioids are at a high risk for dying from overdose when they are released from jail or prison. Studies from Washington and North Carolina have shown a 40-129 times increased risk of dying from overdose during the first two weeks out of prison compared with the general population.

This increased risk for overdose is related to:

• Lower tolerance due to a break in use, or using less while incarcerated
• Returning to a stressful environment where drugs are available

Providing naloxone and overdose education to people involved with the criminal legal system can reduce their risk of dying from overdose after release.

You can also naloxone on-site to prevent an overdose death.

Medications for treatment of opioid use disorder also reduce the risk of drug overdose. To learn about the role of medications for opioid use disorder in the criminal legal system, visit our other website learnabouttreatment.org.

WA State jails and prison staff are encountering fentanyl more frequently. In partnership with several other organizations, we’ve created handouts for Jails and for Corrections Staff.

Resources for Jails

Responding to Suspected Fentanyl or Other Opioids in Jails: It’s Safe to Assist and wallet card for jails

Resources for Corrections Staff

It’s Safe to Give Help: Responding to Suspected Fentanyl or Other Opioids in Correctional Facilities handout and wallet card endorsed by the WA Department of Corrections.

• In Washington under RCW 69.41.095 anyone can have and carry naloxone to use in case of an overdose. Organizations that distribute naloxone and providers who prescribe it are also protected from liability under this law.
• There is a statewide standing that went into effect on August 28. 2019.
  • The standing order acts as a blanket prescription for the state and allows organizations to register with the state Department of Health, and purchase naloxone directly from a pharmacy or company that makes naloxone.
  • Individuals can also go directly to a pharmacy to pick up naloxone without seeing a health care provider first.

Learn more about the WA Statewide Standing Order here.

WA State naloxone laws require that people receive education on overdose response and how to use naloxone when naloxone is distributed or dispensed.

Under the WA Statewide Standing Order you must provide written education on “the proper response to an opioid-related overdose”, including:

• Instructions on the role of naloxone
• recognizing a potential opioid-related overdose
• verifying unresponsiveness
• calling 911 and administering naloxone
• starting rescue breathing
• administering a second dose of naloxone if needed
• and providing post-overdose care

These resources meet the education requirement of the Naloxone Law and the Statewide Standing Order:

• Overdose Response brochure in English or Spanish from stopoverdose.org
• WA State Overdose Prevention and Response Video from stopoverdose.org
• Overdose Response Instructions from WA Department of Health in multiple languages
• Opioid Overdose-Administering Naloxone from WA Department of Health

There are several ways to distribute naloxone to people in the criminal legal system:

• Hand it to people and provide education through video, brochure, and/or a conversation before they leave jail or prison
• Put it in their property with a brochure
• Provide them with information about where to obtain naloxone and how to respond to overdose

While designing your program, consider who should be involved. The program is most likely to be effective if there is buy-in from all levels of staff. Also consider how you will identify people who are the most likely to use naloxone and to accept it from your program.

Although fentanyl overdose has been a topic of concern for first responders and people who work in the legal system, someone responding to an overdose is unlikely to experience fentanyl overdose themselves. Fentanyl is unlikely to be absorbed through the skin or to be aerosolized enough to be a risk through breathing.

For more on how to further reduce the risk of fentanyl exposure, “ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders.”

Make sure you discuss key points around overdose recognition and response. and the resources from stopoverdose and WA Department of Health can be used as a guide.

• In WA State, is legal for anyone to have and carry naloxone to use in case of an overdose.
• Naloxone has no side effects except opioid withdrawal; it can’t hurt, it can only help.
• People often worry about others close to them overdosing. Emphasize that naloxone can be used to help someone else, and they should take a kit if they have friends or family members who use opioids. This also can help if people do not want to talk about their own opioid use or risk for overdose.
• Carrying naloxone is like having an EpiPen for allergic reactions or a fire extinguisher.
• The Good Samaritan Law provides protection from prosecution for minor drug possession for the victim and the person calling 911. It does not cover outstanding warrants or felonies.

People leaving jail or prison have an acutely high risk for dying from overdose upon release. Ensuring they have naloxone can reduce their risk for dying from overdose after release.

People also may be at risk for overdose while they are incarcerated. For example, people may swallow plastic bags of opioids that later burst. Having naloxone available to jail medical staff can also address overdoses during incarceration.

• A Primer for Implementation of Overdose Education and Naloxone Distribution in Jails and Prisons from RTI and the Harm Reduction Coalition
• The National Commission on Correctional Health supports having naloxone in correctional settings as a way to prevent overdose deaths.

People under community supervision, including those on probation and parole, may also be at risk for overdose. Programs should consider providing naloxone or overdose education to people at risk of having or witnessing an overdose.

The American Probation and Parole Association supports distributing naloxone to people on probation or parole. The American Probation and Parole Association has a statement in support of the use of naloxone by community supervision agencies, April 2019.

Some drug courts in WA State distribute naloxone to their participants. Below are resources to support drug courts in providing naloxone:

The National Association of Drug Court Professionals has adopted a board resolution on overdose and naloxone that supports:

• Training for drug court professionals on overdose prevention and response, including administration of naloxone.
• Making naloxone available to drug court participants and others who may be first responders to an opioid overdose.

From the National Drug Court Institute–Naloxone Training for Treatment Court Professionals and Families. Includes:

• Online Training Tool
• Fact Sheet: Naloxone: Overview and Considerations from Drug Court Treatment Programs.

• The National Association of Drug Court Professionals Adult Drug Court Best Practice Standards contains national, research-based, best practice standards for behavioral health care for drug court practitioners.
• Volume I includes guidance on medications for opioid use disorder (p. 44) and clinical diagnostic tools (p.55).
• Volume II includes guidance on preventing opioid overdose (p. 17).

To learn about medications for opioid use disorder in courts , please visit learnabouttreatment.org.