title: High uptake of naloxone-based overdose prevention training among previously incarcerated syringe-exchange program participants.
abstract: BACKGROUND
  Incarceration is common among people who inject drugs. Prior research has shown that incarceration is a marker of elevated risk for opioid overdose, suggesting that the criminal justice system may be an important, under-utilized venue for implementing overdose prevention strategies. To better understand the feasibility and acceptability of such strategies, we evaluated the utilization of naloxone-based overdose prevention training among people who inject drugs with and without a history of incarceration.
  
  
  METHODS
  We surveyed clients who utilize a multi-site syringe exchange program (SEP) in 2 cities in the Midwestern United States. Participants completed an 88-item, computerized survey assessing history of incarceration, consequences associated with injection, injecting practices, and uptake of harm reduction strategies.
  
  
  RESULTS
  Among 543 respondents who injected drugs in the prior 30 days, 243 (43%) reported prior incarceration. Comparing those with and without a history of incarceration, there were no significant differences with respect to age, gender, or race. Those who observed an overdose, experienced overdose, and received training to administer or have administered naloxone were more likely to report incarceration. Overall, 69% of previously incarcerated clients had been trained to administer naloxone.
  
  
  CONCLUSIONS
  People who inject drugs with a history of incarceration appear to have a higher risk of opioid overdose than those never incarcerated, and are more willing to utilize naloxone as an overdose prevention strategy. Naloxone training and distribution is an important component of comprehensive prevention services for persons with opioid use disorders. Expansion of services for persons leaving correctional facilities should be considered.
authors.affiliation: Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, GrJ-504, Boston, MA, 02114, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, UWMFCB 5th floor, Madison, WI 53705, USA. Electronic address: jbarocas@partners.org.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Barocas
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, UWMFCB 5th floor, Madison, WI 53705, USA. Electronic address: lmbaker@medicine.wisc.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: Baker
authors.affiliation: University of Wisconsin, School of Journalism Mass Communication, 821 University Ave, 5164 Vilas Hall 53705, USA. Electronic address: sjhull@wisc.edu.
authors.forename: Shawnika J
authors.initials: SJ
authors.lastname: Hull
authors.affiliation: AIDS Resource Center of Wisconsin, 3716W. Wisconsin Ave, Milwaukee, WI 53208, USA. Electronic address: Scott.Stokes@arcw.org.
authors.forename: Scott
authors.initials: S
authors.lastname: Stokes
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, UWMFCB 5th floor, Madison, WI 53705, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 707 WARF Building, 610 North Walnut St, Madison WI 53726, USA. Electronic address: rpw@medicine.wisc.edu.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Westergaard
mesh_terms: D000328:Adult; D057237:Criminals / Q000193:education / Q000706:statistics & numerical data*; D062787:Drug Overdose / Q000517:prevention & control*; D055030:Drug Users / Q000193:education / Q000706:statistics & numerical data*; D004493:Education / Q000706:statistics & numerical data*; D005260:Female; D040261:Harm Reduction; D006801:Humans; D008297:Male; D015146:Midwestern United States; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use; D018671:Needle-Exchange Programs; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone
keywords: Correctional facilities; Overdose; People who inject drugs; Risky health behaviors; Take-home naloxone