Online Program

319009
Overdose prevention training at the Rikers Island visit house: A novel approach to targeting a high risk population


Tuesday, November 3, 2015 : 3:10 p.m. - 3:30 p.m.

Zachary Rosner, MD, Correctional Health Services, New York City Department of Health and Mental Hygiene, Queens, NY
Ross MacDonald, MD, Correctional Health Services, New York City Department of Health and Mental Hygiene, East Elmhurst, NY
Allison Dansby, MSW, CHS Transitional Health Care Coordination, New York City Department of Health and Mental Hygiene, Queens, NY
Alison O. Jordan, LCSW, Correctional Health Services' Transitional Health Care Coordination, New York City Department of Health and Mental Hygiene, East Elmhurst, NY
Anne Siegler, MPH, Bureau of Alcohol & Drug Use Prevention, Care & Treatment, NYC Department of Health and Mental Hygiene, Long Island City, NY
Amu Ptah-Riojas, New York City Department of Health and Mental Hygiene, Queens, NY
Homer D. Venters, MD MS, Correctional Health Services, New York City Department of Health and Mental Hygeine, Queens, NY
BACKGROUND: Drug overdose is a leading cause of death during the first two weeks after leaving correctional facilities both nationally and in New York City (Binswanger 2007; Lim 2012). The drug naloxone is effective at reversing overdose. Logistical barriers, including unpredictable discharge dates and security concerns, limit the ability to distribute overdose prevention kits to NYC jail inmates at discharge. The Rikers Island visit house processes up to 1,500 visitors, five days a week. Training friends and family in overdose prevention has the potential to save lives when the recently incarcerated return home.

METHODS: The New York City Department of Health, in coordination with community partners, offered overdose prevention training to visitors entering the jails. Participants received a hands-on training, information on community resources and had the opportunity to pick-up an overdose prevention kit with intranasal naloxone after their visit. Participants were also encouraged to report back if their kit was used. Regulatory changes in September 2014 allowed the program to transition to a standing order model, no longer requiring a physician to write individual naloxone prescriptions for each dose distributed.

RESULTS: A small pilot conducted in April 2014 resulted in 218 visitors being trained and 155 kits distributed. Between June and December, 1406 visitors were trained and 1015 naloxone kits distributed. Eight reversals were reported to program leaders.

CONCLUSIONS: There was significant interest in overdose prevention training when offered in a high volume jail visitor center. The standing order model allowed for flexibility in scheduling and increased kit distribution. The high rate of overdose reversals reported in the first seven months of the program suggest that jail visitors are at elevated risk of witnessing drug overdose. Overdose prevention training for this group may be highly effective.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Describe a new mode of naloxone distribution to an at risk population. Assess interest in overdose prevention training among visitors to a large jail. Analyze barriers to providing overdose prevention training in the jail setting.

Keyword(s): Drug Abuse Prevention and Safety, Criminal Justice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I work as Deputy Medical Director of the Bureau of Correctional Health Services within the NYC Department of Health and Mental Hygiene. In my position I help oversee the medical care and public health initiatives throughout the jail system. Our bureau works in overdose prevention within the jails through our methadone maintanence and counseling programs. We also oversee efforts to connect patients with care and treatment when they return to the community.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.