The Multnomah County Sheriff announced today that beginning June 1 Corrections staff will make available the opioid overdose reversal drug naloxone to individuals leaving county jails. The program comes as new data shows people released from jail are 15 times more likely to die of an overdose in first seven days after leaving jail.
The distribution is part of a broader partnership with Multnomah County’s Public Health and Corrections Health divisions to reduce overdose deaths and curb recidivism by treating addiction as a chronic illness rather than penalizing addiction as a criminal act.
“We’re trying to save lives,” said Sheriff Mike Reese. “Our goal in public safety is to support the rehabilitation of adults in custody. We believe in a continuum of care that connects people to resources.”
The partnership focuses on initiatives to treat addiction and underlying mental health conditions among people who cycle through Multnomah County jails. The Sheriff has also begun work on peer support and how to expand drug treatment in jail.
“The best outcome is when we seize that opportunity to potentially save a life, but also, to connect people to treatment and end the cycle of addiction and incarceration,” said Multnomah County Chair Deborah Kafoury.
Overdose Reversal
Multnomah County’s syringe exchange program, in partnership with Outside In, is the region’s largest provider of naloxone to people who use opioids. Last year alone the programs trained more than 1,000 people on how to administer the drug when someone is experiencing an overdose.
Since launching the distribution program in July 2013, more than 4,000 overdoses have been reversed with naloxone. And 17 percent of those overdoses occurred shortly after people were released from jail or prison. That’s because withdrawal symptoms from a substance abuse disorder can begin within just a few hours of stopping use, causing an individual’s tolerance to previous levels of the drug to plummet, and setting them up for an overdose once they leave the jail.
Inmates know the risk of overdose increases when their tolerance drops — nurses and counselors in the jail make a point to communicate the risk before release — but addiction isn’t rational.
“When you have a substance use disorder, your brain doesn’t do the things that seem logical. Your brain is telling you not to be sick anymore,” said Erin Browne, manager of the County’s syringe exchange program. “We want to make sure people have the tools not to die when our brains are telling us to do things that don’t make sense. By providing naloxone on release, we’re making sure people have the tools to save their own lives.”
Public Health has for years encouraged the Sheriff’s Office to consider distributing naloxone, and that conversation got a boost after Mike Reese took office in 2016.
“The new sheriff was really instrumental in being supportive of this. He said, ‘Let’s do it! What do we have to do to make it happen?” Browne said. “There was a shift that allowed us to move forward.”
Reese in 2018 joined regional health and justice officials for a summit on the opioid epidemic, and publicly committed his jails to being places where change could begin.
“We can have a profound impact on people in our custody by treating them with dignity and respect,” he said. “You can turn people's lives around, help them to feel self worth, by showing them human dignity, and still holding them accountable.”
Momentum grew last year as a Health Officer team member crunched data to confirm suspicions that people are at greater risk of dying from a drug overdose immediately after leaving prison.
The project manager Tyler Swift paired fatal overdose records from 2009 through 2017 with jail booking data from the same time. His research found that 212 people died of an opioid overdose in the year following release from jail, but the risk of death was 15 times greater within the first seven days of leaving detention.
“It’s really stark,” Swift said. “We know that period is essential, and we don’t have time to refer people to go get naloxone. They need it immediately.”
When Swift brought his findings to Reese, he found an enthusiastic advocate.
“There’s a stereotype that corrections is punitive and lacks compassion, and that’s not been my experience,” he said. “There are so many bureaucratic hoops but whenever I’m in a meeting with Mike Reese, he says, ‘What are we waiting for?’ Let’s do it tomorrow!’”
Naloxone is safe to use and stunningly effective at reversing an overdose of opioids. It saves lives, just as a defibrillator restarts a heartbeat, an epinephrine pen halts an allergic reaction, or an inhaler relaxes the muscles around the lungs.
“Not everyone needs to get incarcerated to change their life, but you meet people where they are,” Reese said.
And for those who want to connect to a peer support specialist, see a mental health provider or start treatment, a corrections counselor will help there too.
“We want to leverage that moment of sobriety that jail offers to give that person a different choice,” Reese said. “To let them know, ‘We want to help. You’re sober today. Do you want to change your life?’”