[Read Part 1 of this series here]
No prison in the United States currently has an Overdose Education and Naloxone Distribution (OEND) program that puts naloxone in prisoners’ hands directly. However, they wouldn’t have to reinvent the wheel to implement one. The medical and security infrastructure to do so already exist, and naloxone could be folded in with few adjustments and at almost no cost.
Naloxone kits stored in cells and in bathrooms, or anywhere prisoners are allowed to access it, would be a massive improvement over no accessible naloxone. But naloxone is most effective when people can keep it on their person.
In contrast to OEND focused on communal access, the following routes would make naloxone accessible to individuals. This won’t work for everyone—no matter how robust a “Good Samaritan” policy is implemented, for many people in custody it’s not feasible to be associated with drug use. Which they would be if they requested naloxone, whether or not they use drugs themselves. But by the same token, allowing prisoners to take on that association if they want to—and some would—would make naloxone immediately accessible to not just them but anyone they share a cell or dorm with, without waiting years for a culture change.
Prescription and Over-the-Counter
Prisons dispense medications at what’s known as “pill line.” Or two pill lines, as is the case at Washington Department of Corrections facilities. One line is for medications that are considered a risk for diversion or nonprescription use, and operates somewhat like a methadone clinic; if you take your medication three times a day, then three times a day you go stand in pill line and take your medication under supervision when it’s your turn. The second pill line is for “keep on person” (KOP) prescriptions—medications you can take with you back to your cell to use later. Naloxone could be prescribed by the exact same process, 30 days at a time.
Since 2023, the Food and Drug Administration has approved several naloxone products for over-the-counter sale, meaning you don’t need a prescription to buy them. In prison, however, everything requires a prescription. But for something with no risk of addiction or diversion—aspirin, for example—the prescription will be dispensed KOP.
KOP is also what allows prisoners to carry approved medical equipment, like asthma inhalers. If you have asthma, refilling your KOP inhaler prescription works similarly to how some syringe service programs operate on “one-to-one ” exchange. You have to bring in the old one in order to get a new one.
Another route already built into correctional medical services is what in Washington State is called a Health Status Report (HSR). These are issued to prisoners by medical providers, and essentially serve as a license to carry various medical devices and equipment outside the scope of regular medication. If you use hearing aids, you need a KOP prescription for the batteries but you get the devices themselves through an HSR. If you have smoking-related complications and need a CPAP machine, same thing. Providers can issue an HSR for anything if there’s sufficient medical cause.
There’s also a non-medical route: Sell naloxone at commissary.
Issuing naloxone to prisoners this way would be a natural fit for smaller OEND pilots, because it requires the medical provider to meet with the participants in person. Infection control staff would be the logical choice at any institution, due to the correlation between substance use and HIV/hepatitis C.
There’s also a non-medical route: Sell naloxone at commissary. This would be the equivalent of over-the-counter. You do need a prescription for aspirin, but you can also buy it at commissary if you can afford to.
Sales could be done on a one-to-one protocol. Some county jails have sold vapes that way, albeit at a higher markup than corrections departments could probably get away with for naloxone.
The kits would be considered too sensitive to be bagged up and delivered alongside standard commissary orders, but there’s already an existing one-to-one protocol for items like that—they get issued as property. TVs, for example. You’re only allowed to have one, and you can’t buy a new one from commissary if you don’t turn in the old one.
Adding naloxone to a prison system’s property matrix, the list of items prisoners are allowed to have, would potentially involve a policy change. Which is no reason it can’t be done, it just means it administration would have to go out of their way to do it, while the other options could really just be folded into existing infrastructure.
Security
Generic intramuscular naloxone, as opposed to nasal sprays like Narcan, is for the time being at least a non-starter at probably any US corrections department because it comes with a needle. And many have assumed that an OEND pilot can’t use the nasal sprays for the same reason—they also contain a hollow needle. It’s what punctures the sealed compartment holding the actual naloxone when the device is deployed.
Some prisoners are allowed to have embroidery needles, or paperwork containing staples. Glucometers, with the little lancet to check your blood sugar, are issued HSR. Those aren’t considered security risks because they aren’t hollow. The needle inside the nasal spray devices is hollow and, though it’s a larger gauge than just about anyone would prefer, could be used to inject drugs. However, the security measures to control this already exist.
Every time someone with asthma picks up their new KOP inhaler, it comes labeled with their ID information, the date the prescription was filled and the date it expires. In Washington State, officers are already required to inspect everyone’s cell every day and do more thorough inspections at least once a week. All they’d have to do is check that the device hadn’t been tampered with, i.e. the plastic casing hadn’t been cracked open to get at the needle inside.
Medical equipment that could been used as weapons—canes, for example—is issued all the time.
Another option is to issue prisoners the same plastic boxes that naloxone is already kept in at officer stations. The boxes aren’t locked, but have a tamper-proof security tag. If the box has been opened, there’s no hiding it. Officers could just check whether the box has been opened during those same routine inspections.
Medical equipment which has on occasion been used as weapons—canes, for example—are issued with an HSR all the time. It’s understood that the potential security risk is negligible, and greatly outweighed by the need.
Whenever medical writes an HSR, a copy goes to the staff in the prisoner’s living unit notifying them to inspect it during cell searches, as well as what signs of tampering to look for.
Naloxone is not dangerous. It can’t be used to get high, is not toxic if administered incorrectly, and would have no monetary value in prison.
Prisons exist to control and surveil. They’re designed to enforce exactly these kinds of protocols. The resistance to giving prisoners access to naloxone doesn’t come from concerns about security. It comes from cop culture and the moralizing of drug use, and of anything that suggests prisoners have anything that looks like autonomy.
This isn’t asking them to do anything they don’t already do. Just asking them to do their jobs.
Part 3 of this series will be published later in December
Image (cropped) via Michigan Department of Corrections
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