Sentenced to Death: How the Lack of Naloxone Provision Behind Bars Leads to Preventable Death

By Cherise Thomas

Despite popular misunderstanding, drug use is ubiquitous in America’s prisons and jails. Far from an opportunity for recovery, conditions of incarceration increase a person’s risk of fatal opioid overdose due to several factors: forced abstinence or decreased use results in lower tolerance, limited access to treatment, and little to no access to overdose reversal in jails and prisons. All of this leaves those with opioid use disorder (OUD) tremendously vulnerable both inside carceral facilities and on re-entry to the community.

In April of 2021, a young woman named Olivia died of a fentanyl overdose in a county jail in Georgia. Her jailers knew that she had recently used drugs, had a substance use disorder (SUD), and was high risk for withdrawal. Despite this, they failed to thoroughly search her during intake and did not provide timely treatment. She was placed in solitary confinement, where she remained even after a nurse recommended that she be transferred to another facility for the management of her withdrawal symptoms. In an attempt to draw attention and get help, Olivia swallowed fentanyl she had stashed in her clothing. Even after carceral staff confirmed that she swallowed the drug, they did not call emergency medical services immediately. Naloxone is not readily available in jails, but EMS workers usually carry it. When administered, it is remarkably effective at reversing an opioid overdose, albeit at times temporarily. Olivia was never given a dose and was found dead several hours later. She had been arrested for shoplifting.

In December of 2022, another woman, Christina, died of a methamphetamine and fentanyl overdose in Pulaski State Prison in Georgia. Before her arrest, Christina also struggled with a substance use disorder. Her father, like many others, believed that jails and prisons were places where people did not have access to drugs. He believed that she would be able to address her SUD while incarcerated. He thought his daughter would be safe.

Deaths like these are driven by the availability of unregulated and potent drugs like fentanyl. The criminalization of these drugs only exacerbates this problem. This is known as the iron law of prohibition. Additionally, laws that punish and stigmatize people with SUDs contribute to their social and economic marginalization, making recovery for many further out of reach.

It can also lead to riskier use practices, such as using alone. To be clear, the criminalization of drugs does nothing to decrease their use or availability. After more than one trillion dollars spent on the “war on drugs”, there is nothing to show for it save for much otherwise preventable harm. There is no way that the carceral system can provide a solution to an issue it in part created and sustains. There are, however, ways to reform the system and reduce its capacity for harm.

What We Can Do

One place to start is with education. Preventing an overdose is only possible if one can recognize the signs. People experiencing opioid overdose are often unarousable, with pinpoint pupils, slowed, shallow breathing and cold or clammy skin. Having healthcare professionals teach incarcerated persons and guards to recognize signs like these could save lives.

It would also be helpful for all incarcerated persons to have Naloxone readily available to them, whether that be in their cells or in a common area. Many incarcerated persons end up using drugs in isolation as they are afraid of being punished. Having Naloxone readily available will allow for prompt administration, giving people time to call for help. In addition to this, it would be important for Georgia’s Medical Amnesty Law to provide immunity to incarcerated persons seeking help for themselves or others. Supplying guards with Naloxone may also be helpful, even with the inherent mistrust between them and incarcerated persons. Elected officials should stop perpetrating the myth of drug free jails and prisons and instead provide naloxone, as it would save lives.

Preventing overdoses in jails would likely prove cost-effective as well. When Olivia died, $2.1 million dollars was paid to settle her case in court. It currently costs about $50 for a two-pack of over-the-counter Naloxone (Narcan). With that money, they could have bought 42,000 packs.

Another population that would benefit from a Narcan supply are those with OUD preparing for release. Being released with Narcan in hand would decrease their risk of dying from an overdose. Of course, this is a bare minimum. Connecting this population to resources within the community would help them to access support, including critical medications for OUD. Jails and prisons should coordinate with clinics that specialize in the medical and social management of OUD and other SUDs, providing immediate linkage to care for formerly incarcerated persons.

When considering reforms, it is also important to consider potential pushback.

Many believe that providing Narcan would encourage or increase the use of opioids. This is a myth. Several studies have shown that providing people with Narcan does not increase drug use. Others are concerned about the cost of providing Narcan. The example above shows that the true cost comes with deaths that could have been prevented, in both human and financial terms. Some will argue that it would be better to keep drugs out of jails and prisons once and for all. Unfortunately, this is a pipedream. This is in part due to financial incentives. For example, drugs are smuggled into Georgia prisons by employees of the Georgia Department of Corrections (GDC), with similar cases documented across the country.

As it stands, the criminal legal system is not equipped to handle an overdose crisis they are in large part responsible for. Overhauling the entire system will take time. In the interim, adopting practices to reduce the harm done is vital to save lives on the path towards permanent change.