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Ontario jail giving naloxone to inmates upon release

Inmates released from the Hamilton Wentworth Detention Centre are being equipped with naloxone kits to combat opioid overdoses.

Research shows that the rate of death from overdose is more than 50 times higher in the two weeks following a release from custody.

“There is an over-representation of substance use disorders, and there also is an over-representation of risky substance use,” among Canada’s incarcerated population, said Dr. Fiona Kouyoumdjian, of St. Michael’s Hospital at the University of Toronto.

She is a part time physician at the Barton Street jail and advocates for the provision of naloxone, an antidote for opioid overdose.

Barton street jail

Barton Street jail is one of two detention centres in Ontario currently providing naloxone kits, with eight more expected to start in the New Year. (Jeff Green/CBC)

People serving time in jail generally have less access to the same substances than they do when they’re out in the community, said Kouyoumdjian.

This can result in a number of challenges, including new strains of substances made available on the streets, or sourcing varying substances from new dealers. But the biggest issue, she says, is tolerance.

‘The idea that they would go out and die from something that is preventable is really disturbing.’
– Dr. Fiona Kouyoumdjian

“Their body’s ability to tolerate high doses decreases while in jail, so when they leave they’re more susceptible to experiencing an overdose,” she said.

And today, those leaving custody enter a country riddled with drug-related issues. The opioid crisis has become an issue across Canada in 2016, with more than 35 people dying in Hamilton alone from an overdose. That compares with 18 people dying of opioid toxicity in the city in 2015.

It’s a problem many think could be stopped, easily.

Naloxone injection vials

Naloxone injection vials like these are included in every kit, and physicians hope will save the lives of former inmates at high risk of overdose. (Cameron MacIntosh/CBC)

“In the jail we see a lot of young people who are parents, who are children, who are involved in communities, and the idea that they would go out and die from something that is preventable is really disturbing,” said Kouyoumdjian.

The distribution of naloxone in Hamilton is part of a larger program lead by the Ministry of Community Safety and Correctional Services and the Ministry of Health and Long Term Care, that aims to equip at-risk released inmates in the province with the kits and education.

“Many of the inmates in the provincial correctional system have complex social, medical and behavioural factors at the time of admission, including substance abuse and addictions,” said Greg Flood, spokesman for the Ministry of Community Safety and Correctional Services.

In an email to the CBC, Flood explained that the naloxone kits first rolled out on Oct. 31, 2016 at two facilities, as part of the first phase of the ‘Take Home Naloxone’ program.

So far, Hamilton’s Barton Street jail, and the Vanier Centre for Women in Milton, remain the only institutions providing kits.

“The ministry expects that eight more correctional institutions will begin distribution of naloxone kits early in the new year, with the remainder of provincial correctional facilities following later in the spring,” wrote Flood.

Wallet cards are distributed to inmates in the meantime, with contact information to access naloxone kits in the community, which are available free of charge.

naloxone

The opioid antidote naloxone can save lives during overdoses. (Stefan Labbe/CBC)

A long time coming

It’s a program that Kouyoumdjian says has been in process for a long time.

“This has been an ongoing discussion of months to years for this distribution to start,” she said.

While information is certainly powerful, she argues that with the current crisis there’s a lot more that needs to be done, especially with regards to those incarcerated.

‘We have the opportunity to intervene to help people who want to improve their health.’
– Dr. Fiona Kouyoumdjian

“We have the opportunity to intervene to help people who want to improve their health,” she said. “It’s wonderful if we can provide information, but it is even better if we can give people the specific tools that they need to improve their health.”

The kits provided to those released from custody are the same ones that are available for free from a pharmacy. A hard case with disinfectant, gloves, a mask, naloxone and syringes, plus information on responding to an overdose.

Kouyoumdjian’s hope is that by equipping individuals with the tools and knowledge to survive an overdose, they can start working back to the root of the problem, education.

“The provision of naloxone is a very downstream intervention,” she said. “Ideally we would be able to reach people before they have a serious overdose where they need to use a reversal agent.”