In the free world, bystanders who call EMS to an active overdose receive legal immunity according to state-level Good Samaritan laws. The idea behind these laws is many people at the scene of an overdose were using drugs themselves, and hesitate to call 911 knowing cops will probably follow. If people can be punished for intervening in an overdose, they often won’t and the victim will die.
Good Samaritan laws vary substantially from state to state in terms of how much protection they offer, and to whom. But even the weakest ones provide, at minimum, immunity for the person who calls 911. In prisons, where department policies govern people’s lives the way laws do out on the street, it’s the opposite. Any prisoner who sees another prisoner overdosing is required to report it, and will be placed under investigation the moment they do.
Prisoners at the scene of an active overdose usually have three options: Try to flag down a cop; try to keep the other person alive without help; or do nothing.
Flagging down a cop is the equivalent of calling 911. If you do this, you’re a suspect in the incident. It’s going on your record. Bulletins about suspicious behaviors to monitor you for are being sent out to staff. Your cell is getting searched, your property is getting broken in the process, your mail is getting read, your phone calls are getting listened to. You’re probably getting drug-tested. If they find anything, you’re getting an infraction. Even if the investigation ultimately finds you not guilty, just being investigated in and of itself can cost you your job, your visitation privileges, “good behavior time,” etc.
And from fellow prisoners, you get what’s called a “snitch jacket.” Assuming the person who overdosed survived, whatever punishment they’re now dealing with—you did that to them. Or at least that’s how the population will see it. If you’re affiliated with a gang, you’ll face specific punishments from them too, but you’ll be ostracized by everyone. No one will talk to you or do business with you, even if they think you did the right thing, because now they’ll be punished for associating with you.
If you want to avoid this but don’t want the person you’re with to die, you have to try to save them without naloxone. Usually people do this with rescue breathing and ice, if the ice machine’s not broken. However, prisoners are not allowed to render medical aid to one another—so if officers catch you doing any of this, then you’re still facing an investigation and all those same sanctions.
None of this changes based on whether or not the victim dies; if they do, sanctions for trying to save them might be slightly more lenient, but that’s all.
So current policy incentivizes the third option: Do nothing. Even if your cellie overdoses and dies in their bunk while you’re three feet away, you can probably weather the resulting investigation by just answering every question with, “I was asleep.”
With opioid overdoses on the rise, @LASDHQ wants to ensure that inmate safety is of utmost priority. I have implemented a Narcan Custody Pilot Project, in less than ten days the pilot project saved three inmates from an opioid overdose. #NARCAN https://t.co/Op1if2zY4f
— Alex Villanueva (@LACoSheriff_33) May 28, 2021
The way to avoid all this, and reverse more overdoses more often, is for prisons to implement Overdose Education and Naloxone Distribution (OEND) programs that allow people in custody to use naloxone themselves. But for prisoners to be able to do this safely, they need the policy equivalent of a Good Samaritan law.
An effective Good Samaritan policy would explicitly grant immunity from disciplinary sanctions as well as immunity from any formal or informal retaliation. And—most importantly—it would prohibit staff from investigating any prisoners as suspects in the overdose, or using the overdose as a pretext to open other investigations into the people involved.
These protections would need to apply to anyone who retrieves or administers naloxone under an OEND program; anyone who assists them; anyone on the receiving end of the naloxone; anyone who reports the incident, if applicable; and the cellie of anyone above, since they’ll be considered involved by association. Often this would be a total of two people, but not necessarily.
OEND programs have already been piloted in some county jails in the United States. But they’ve never been done at a state or federal prison, and they should be. There are half a dozen or so potential pathways for getting naloxone into the hands of prisoners, all of which are independent of one another and could in theory be pursued concurrently.
The first two involve storing naloxone in common areas, like bathrooms.
General Population Unit Bathrooms
In most county jail OEND pilots, naloxone was made accessible to people in custody by putting it in the dormitories where anyone housed there could reach it. Minimum- and medium-security prisons across the country all tend to use a similar layout—either open dorms, or cells with doors that aren’t locked at night, leaving 24/7 access to common areas—so that county jail model could be easily replicated in prisons. However, it shouldn’t be.
For naloxone to be accessible to prisoners, it can’t be kept anywhere that’s surveilled. To be clear, there is no privacy in prison—every moment of every day, no matter what you’re doing, you’re doing it in front of cops. But there’s a huge difference between being surveilled by 24/7 security cameras, like in the dorms and day rooms, versus by an officer doing their randomized walk-through once each hour. Like in the bathrooms.
At Washington Corrections Center (Shelton) where Jonathan is incarcerated, the bathrooms are in the day rooms. From probably any prison day room in the country, you can be sitting at a table and see straight into the bathroom. But you can’t see someone actually sitting on a toilet or taking a shower, and while officers do walk through the bathrooms they don’t stare into them all day from a booth. Bathrooms are the only places that don’t have cameras. They’re where most ODs occur, and where naloxone needs to be stored in order to be accessible. The kits could be kept in a box that prisoners could open anonymously, without any alarm going off, and flip a flag to indicate it needs to be refilled.
Wet Cells
In late 2023, a county jail in central Washington began putting naloxone kits inside each cell. Previously the facility had kept the kits outside of each cell. But after a non-fatal OD that put someone in the hospital for five days, jail administrators agreed on giving direct access to people in custody. Each cell has at least two doses, and larger cells have four.
This model—naloxone inside each cell—is what’s needed wherever people are incarcerated with little or no access to common areas. This is the “wet cell” layout, where each cell has a toilet and sink rather than everyone sharing a bathroom down the hall.
This layout is also widely used across the country; often in higher-security prisons. Or in higher-security parts of a prison, like the living units that are separate from the general population units at Shelton.
Shelton is the Washington State intake facility for everyone being processed into the men’s prison system from the county jails. Every state prison system has a equivalent facility.
The two-person cells in the Shelton Reception Units are wet cells, so no one has unsupervised access to day rooms or showers. People housed in the R-Units go to the chow hall, yard, gym, and that’s it. So the naloxone needs to be in each cell not only because that’s where the ODs happen, but because if it’s kept anywhere but their cells they won’t be able to reach it.
Early in the COVID-19 pandemic, Shelton was at one point using the R-Units as isolation housing for prisoners who tested positive. One night when Jonathan was there, it was after midnight when he and the 50 or so other prisoners on the same tier started to hear yelling. Not the usual kind of prison yelling; frantic, sustained yelling. After a few minutes, they realized that it was coming from a different tier. From 200 feet across a courtyard, everyone on the other tier was yelling at their tier for help.
It took another 10 minutes for everyone on Jonathan’s tier to realize this, organize enough to get everyone to quiet down so they could hear the message, and several more minutes of yelling back and forth before they understood what was happening: Someone on the other tier had had a heart attack; everyone there had been yelling and banging the walls for 45 minutes trying to get an officer’s attention. But no one came, so they’d opened the windows to yell at Jonathan’s tier so that they could start banging and yelling to get an officer’s attention, and hopefully have someone sent over. Which is what ultimately happened, after another 15 minutes or so. Had it been an overdose, no one would have made any noise at all.
Officers having naloxone isn’t enough. Even if prisoners tried to report every overdose, even if officers knew where the naloxone was and were willing to use it, it wouldn’t be enough because—especially in the most heavily secured places—they’re always the last to know and last to arrive. The most effective first responders, the people best-positioned to use naloxone, are the people who are there all along.
Part 2 of this series will be published in December
Photograph via San Diego County Sheriff’s Office
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