Abstract
BACKGROUND: Opioid-related overdose is the leading cause of mortality among individuals recently released from incarceration in the U.S. Naloxone is an FDA-approved opioid antagonist medication designed to rapidly reverse opioid overdose. Despite evidence of its acceptability and effectiveness at reducing the risk of opioid overdose death after release from incarceration, only an estimated 25% of US jails provide naloxone upon release. This study examines the effectiveness of the HEALing Communities Study (HCS) Communities That HEAL (CTH) intervention on enhancing access to overdose education and naloxone distribution (OEND) in participating jails in Kentucky, New York, Massachusetts, and Ohio. METHODS: Communities were randomized to intervention (n = 34) or wait-list control (n = 33) arms stratified by state. Jail-based surveys (n = 59) were implemented at three time points during 2019 to 2022. Generalized linear mixed models (GLMM) with imputation captured intervention effects during the evaluation period (July 1, 2021-June 30, 2022). Interpretation of results was informed by the Practical, Robust Implementation and Sustainability Model framework. RESULTS: The CTH intervention was significantly associated with the hypothesized outcome, resulting in a greater number of jails providing overdose education (H1, relative risk(Adj) = 1.51 [95% CI: 1.09, 2.08], p = 0.013) and the number of jails providing naloxone upon release (H2, relative risk(Adj) = 1.49 [95% CI: 1.05, 2.13)], p = 0.027). External factors related to OEND implementation, such as correctional health care models, available resources, and state COVID restrictions, varied across communities. CONCLUSIONS: The CTH intervention engaging community coalitions to deploy evidence-based practices was effective in increasing OEND implementation in jails, helping address elevated overdose risks for individuals during and post-release from incarceration. Partnerships between state, community, and jail-based stakeholders are needed to assure expanded access to this lifesaving, evidence-based approach. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40352-025-00353-5.