South Bay House of Corrections Shifts to a Harm-Reduction Approach to Educate Inmates on the Future Risk of Opioid Overdose Upon Release

Roberto Sanchez, Program Manager for Overdose Prevention at Boston Public Health Commission

Individuals who have recently been released from the House of Corrections are considered to be at high risk for experiencing an opioid overdose, due to a decrease in drug tolerance due to having been drug-free for a period of time. As an intervention, the Roxbury-Jamaica Plain Substance Abuse Coalition went into the correctional facility to educate the inmates on opioid overdose prevention. The program consists of five classes and a graduation ceremony in which three men are selected to teach an audience of their peers about their increased risk of opioid overdose upon release. The classes are structured around information gathered from the inmates, such as their experiences with overdoses, opioids, and the police. Over time, the program developed into a model where inmates taught the program to each other and adopted a harm reduction approach.

Robert Sanchez of the City-wide Overdose Prevention Program and John Dolan, a Supervisor of the Men’s Treatment Programs at the South bay House of Correction discussed the controversy of a harm reduction model. Moving from an abstinence only model to a harm reduction model creates controversy because some believe that it may enable people to continue use. However, John Dolan explained that this approach is about saving lives so people have an opportunity to recover.

Using this approach, inmates who have become peer-leaders teach other inmates about Narcan and overdose reversal.  Having inmates teach one another is an extremely effective approach because it brings a sense of credibility to the information being delivered. When information is delivered to an individual by someone who is relatable (comes from a similar environment or similar situation) or has first-hand experience with the subject matter, the information is more likely to have a bigger impact on the audience and will be retained.

The program has been successful not only in that it is very popular with the inmates because they have seen the accomplishments of those who have participated in it in the past, but also in spreading the word about Narcan outside of the correctional facility. The men have reported that they tell their friends and family about Narcan through letter-writing and explain why they should get informed about it. In the two years that the program has been running, there have been 16 graduations and over 400 inmates who have graduated. In addition, over 2,000 men have received the information by sitting in the audience, listening to what their peers have to say.