Sheriff giving out Narcan to ex-inmates
The Harris County jail this month became the second lockup in the state to equip departing inmates with grant-funded supplies of the overdose-reversing drug naloxone, the latest push in the sheriff ’s ongoing efforts to rely on harm reduction approaches for addressing opioid addiction.
Jail staff every month will dole out two-dose kits of the life-saving nasal spray to more than 100 atrisk inmates on their way out the door, in the hope that arming drug users with the means to save a life could mean fewer fatal overdoses.
“We know that many individuals are going to be detoxing while they’re in our custody, and we know that people are highly susceptible to overdose upon release,” Harris County Sheriff Ed Gonzalez said. “We want to at least be proactive on providing a tool — an evidence-based practice — to help save lives.”
Police departments across the country have increasingly begun supplying officers and deputies with naloxone, but the decision to provide the drug, also known by the brand name Narcan, to departing inmates is less common.
The move comes two years af
ter the jail became the first in Texas to offer Vivitrol, a drug designed to help curb cravings and prevent relapses and just before officials hope to start offering injections of buprenorphine, another medication used to help former users maintain long-term sobriety.
Federal grant
Naloxone is a drug that blocks the effects of opioids and can be used to stop overdoses from powerful narcotics such as heroin, painkillers and fentanyl. Once given as an intramuscular injection, it’s now available over the counter in a user-friendly nasal spray.
The Harris County Sheriff ’s Office began equipping deputies with doses of the spray in mid-2017.
But as more correctional facilities, including lockups in Chicago, Pittsburgh and New York City, began giving the medication to departing inmates, Harris County jail officials decided to follow suit.
Money for the life-saving drug is not coming out of the sheriff ’s office budget, but through federal grant dollars filtered through the state and to the University of Texas Health San Antonio School of Nursing. There, associate professor Lisa Cleveland oversees the $19 million of funding used to purchase and distribute naloxone across the state — some to jails and some to other populations in need of it.
Earlier this year, the program began its first efforts to reach incarcerated populations by giving the drug out to inmates leaving the Bexar County jail.
“People being released from incarceration are 40 times more likely to die of overdose in the first two weeks after release than the general population,” Cleveland said.
Those early weeks after an inmate’s release are particularly high risk because the sober time behind bars can decrease a user’s drug tolerance and leave them more susceptible to a fatal overdose.
The jail in Harris County on Oct. 9 started giving out the first of its two-dose kits to inmates, according to Dariel Newman, the facility’s head nurse of quality improvement.
“They were excited,” he said, “but prior to giving them out, we do education while they’re inhouse.” As of last week, the local lockup had a starting supply of roughly 1,200 doses, Newman said. The goal is to give out a two-pack kit to anyone leaving the jail who is in the facility’s Vivitrol program, has a history of opioid use or lives with or around opioid users.
With just more than 200 of the inmates booked in every month self-identifying as opioid users, officials expect to give out more than 100 kits every month.
According to Katharine Neill Harris, a researcher at Rice University’s Baker Institute for Public Policy, expanding harm reduction programs is a good strategy from a public health standpoint.
“There are some people who get concerned about the idea that when somebody has Narcan on them, they’ll think that they can use more heroin because they have a way out,” she said, adding that those fears are not supported by existing research.
“People don’t want to overdose,” she said. “This is something that is a way to save lives, and it doesn’t encourage heavier use.”
‘Part of the solution’
Even as the jail is expanding naloxone access, officials are also laying the groundwork to expand socalled medication-assisted treatment options. Often considered the standard of care for opioid addiction, medication-assisted treatments involve the long-term use of prescription drugs to curb opioid cravings and make it harder to get high.
The three drug options — methadone, buprenorphine and naltrexone — all involve at least a few months of medication, often in combination with therapy.
The newest and least-studied of those drug is naltrexone, a monthly shot the jail began making available to qualifying inmates nearing the end of the their time behind bars. Known by the brand name Vivitrol, naltrexone is nonaddictive, nonnarcotic and has no street value — three traits that have made it appealing to jails and corrections departments, some of which may not be comfortable with other treatments such as methadone or buprenorphine.
When drug-maker Alkermes agreed to donate initial doses to the jail back in 2017, the initiative was intended as a temporary pilot program. More than 120 patients later, that pilot has settled into a longer-term plan and the drug company has agreed to continue providing 100 doses of the drug per year, Newman said.
But Vivitrol isn’t always the best option for every patient, so now the jail is looking to expand and hopes to begin offering shots of buprenorphine, a drug once available only in the form of pills and water-soluble strips. Jail officials are still working out where they’ll get the drug, but they’ve already tackled some of the regulatory and logistical hurdles needed to clear a path.
“We want to be part of the solution,” Gonzalez said, “and not part of the problem.”