Take-home naloxone on release
The criminalization of drug use leads to a high representation of people who use drugs within prison populations: an estimated one-third to half of all individuals entering prison have a history of drug use.
People in prison also tend to have poorer health than the general population, compounded by challenging prison conditions like overcrowding and limited access to healthcare and harm reduction services. Consequently, individuals in prison face a significantly higher risk of contracting infectious diseases and other adverse health outcomes than the general population. 15 year Norwegian study shows 85% of all deaths in the first week of release from prison are from drug overdoses [^1].
The UN Standard Minimum Rules for the Treatment of Prisoners, known as the Nelson Mandela Rules, mandate that individuals entering prison should be assessed for signs or risks of drug withdrawal, and provided with any necessary treatment (Rule 30c). This rule is interpreted to include harm reduction services, meaning that these services in prison should be as accessible, available, high-quality, and voluntary as they are for the general population.
For more information on prison standards, see our course "International Prison Standards"
Take-home naloxone is available upon release from prison in at least one facility across 11 countries, primarily in Europe (France, Germany, Italy, Ireland, Norway, Estonia, Lithuania, Ukraine) and North America (Canada and the USA), as well as in one program in Oceania (Australia) [^2]. However, coverage varies widely. For instance, in Italy, only 3 out of 190 prisons provide naloxone on release, whereas it is available in most prisons in British Columbia, Canada, and Victoria, Australia, although this differs by region. In some areas, like France, a prescription is required, while in others, distribution is supported through civil society partnerships. In Ireland, the Irish Red Cross offers peer-to-peer programs focused on overdose prevention and naloxone training, helping individuals access naloxone when they leave prison [^2].
Within prisons, naloxone is typically administered only by staff, limiting its effectiveness. Staff may not always be immediately available in overdose situations, and delays in response can mean the difference between life and death.
Country example: Schotland, UK
Scotland has the highest rate of drug-related deaths in Europe. In 2023 1172 people in Scotland died from a drug overdose [^3].
In 2017 Scotland has launched the project “My first 48 hours out – comprehensive approaches to pre and post prison release interventions for drug users in the criminal justice system”. A major focus of the national programme was to ensure that naloxone was provided to prisoners on-release because of their elevated risk of overdose and drug-related deaths within the weeks following liberation [^4].
The immediate time after release (“my first 48 hours out”) is a critical time for action, when the cooperation between prisons, healthcare providers and NGOs is key in ensuring continuity of care and where targeted interventions can save lives from overdose and build a path towards engagement into further treatment and rehabilitation for people who use drugs.
Training was offered to people with a history of opiate use, and was provided by NHS staff, during their sentence, often within the 6 weeks prior to release. A naloxone kit was placed in their personal belongings by reception staff which is handed to people at the point of release [^5].
In addition, Scottish Drugs Forum has delivered ‘peer education’ training to numerous groups of prisoners across Scotland to allow them to train others within the prison.
This approach has increased the acceptability of naloxone within the Scottish prison estate and undoubtedly assisted the staff to increase the number of kits provided.
Additional material on this project can be here: https://sdf.org.uk/wp-content/uploads/2024/05/My-first-48-hours-out-My-First-48-Hours-Out-Guidelines-for-naloxone-provision-upon-release-from-prison-and-other-custodial-settings.pdf
Naloxone-on-release in other countries in Europe
- Bukten, A., Stavseth, M. R., Skurtveit, S., Tverdal, A., Strang, J., and Clausen, T. (2017) High risk of overdose death following release from prison: variations in mortality during a 15-year observation period. Addiction, 112: 1432–1439. doi: 10.1111/add.13803.
- Harm Reduction International, (2024), Global State of Harm Reduction 2024, HRI, London.
- Scottish Drugs Forum (2024): We can prevent drug deaths. We just need to know how. Scottish Drugs Forum, Glasgow: 2024.
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Bird, S.M.; Hutchinson, S.J. (2003): Male drugs-related deaths in the fortnight after release from prison. Scotland, 1996–1999. In: Addiction 2003 (98):185–90.
- Horsburgh, K & McAuley, A 2018, 'Scotland's national naloxone program: the prison experience', Drug and Alcohol Review, vol. 37, no. 4, pp. 454-456.