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San Francisco County Jail Overdose Education and Naloxone Distribution (OEND) Program

A jail-based overdose prevention intervention that reaches a previously unengaged and high-risk population for opioid overdose

In recognition of a population that is at high risk for opioid overdose after release from incarceration, San Francisco County Jail Overdose Education and Naloxone Distribution (OEND) Program first began as a pilot program delivered to one pod in 2013 through a collaboration with Jail Health Services and the Drug Overdose Prevention and Education (DOPE) Project. It has since expanded to the entire jail. 

Jail House Services (JHS) determines who is being released within the next 30 days on a monthly basis, and all identified individuals soon to be released are invited to attend the OEND training. Jail House Services has been trained on OEND by the DOPE Project.  After watching the “Staying Alive on the Outside” video and discussing overdose prevention, recognition, and reversal with staff, participants indicate whether they would like naloxone to be placed in their personal property. Upon release, those who received naloxone meet with JHS to review how to administer naloxone. 

A presentation on the NEXT study which evaluated this program can be found here and contact information and commentary from the lead researcher on how to implement a similar program can be found here. 

An implementation guide to start a similar program can be found here. A similar program has been implemented in the New York State prison system. 

Of the 427 participants that received naloxone, only 3.5% had previously received OEND training and 32% reported reversing an overdose.

Continuum of Care
Harm Reduction
Type of Evidence
Peer-reviewed
Replicated
Response Approach
Educational
Overdose prevention
Peer-reviewed Article
Overdose Education and Naloxone Distribution in the San Francisco County Jail
Related Resources
A Primer for Implementation of Overdose Education and Naloxone Distribution in Jails and Prisons
SAMHSA Opioid Overdose Prevention Toolkit
Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States
Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States
A Systematic Review of Community Opioid Overdose Prevention and Naloxone Distribution Programs
Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects
Partnering with Jails to Improve Reentry: A Guidebook for Community-Based Organizations
Reentry Matters: Strategies and Successes of Second Chance Act Grantees
Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit

Evidence of Program Effectiveness

Evidence shows that this program was successful in reaching a high-risk population that had never been trained to use naloxone, and that nearly a third of the participants reversed an overdose after training: 

"During 4 years of operation, 637 people participated; 67% received naloxone upon release, of whom only 3.5% had been previously trained in community-based OEND programs. Of those who received naloxone, 32% reported reversing an overdose and 44% received refills from community-based programs after reentry." (Wenger et al., 2019)