Importance: Opioid overdose (OOD) accounts for more than 80,000 deaths per year in the U.S. People who use drugs leaving jails face particularly high OOD risk, and may correspondingly benefit from opt-out naloxone distribution.
Objective. To explore the population impact of opt-out naloxone distribution upon jail release to reverse OOD among people living with opioid use disorders.
Design. We use the agent-based Justice-Community Circulation Model (JCCM) to model a synthetic population of individuals with and without histories of opioid use. We examine 27 experimental scenarios to capture diverse strategies of naloxone distribution and use. We then employ sensitivity analysis to identify critical mediating and moderating variables that affect population impact and a proxy metric for cost-effectiveness—the direct costs of naloxone kits distributed per death averted..
Setting. We used epidemiological data from greater Chicago, Illinois to identify parameters pertinent to our synthetic population.
Findings. Opt-out naloxone distribution upon jail release is estimated to reduce post-release OOD mortality by more than 20%. Sensitivity analyses indicate that presence of willing and capable bystanders at OOD reversal are prominent moderators of population impact of such interventions. The costs of distributed naloxone kits are estimated to be below $30,000 per averted death in all scenarios.
Conclusions. Naloxone distribution at jail exit can reduce opioid overdose mortality. Training and preparation of proficient and willing bystanders are central factors in reaching the full potential of such interventions.