1. Rose A. Rudd et al., "Increases in Drug and Opioid Overdose Deaths — United States, 2000-2014," Morbidity and Mortality Weekly Report 64, no. 50 (2016): 1378-1382; Rose A. Rudd et al., "Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010-2015," Morbidity and Mortality Weekly Report, no. 65 (2016): 1445-1452, DOI: https://perma.cc/UXB2-AGB4. Prescription opioids are medications that relieve pain by reducing the intensity of pain signals reaching the brain. Medications falling within this class include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine, and related drugs. Heroin is an opioid drug that is synthesized from morphine. See National Institute of Drug Abuse, “What are opioids?” November 2014, https://perma.cc/D7AH-LVYZ; and National Institute of Drug Abuse, “Drug Facts: Heroin,” October 2014, https://perma.cc/K9BN-27MK
  2. Haeyoun Park and Matthew Bloch, “How the Epidemic of Drug Overdose Deaths Ripples Across America,” The New York Times, January 19, 2016, http://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html.
  3. Robert Wood Johnson Foundation, The Facts Hurt: A State-by-State Injury Prevention Policy Report (Washington, D.C.: Robert Wood Johnson Foundation, 2015).
  4. Congress, “Comprehensive Addiction and Recovery Act of 2016,” https://perma.cc/5L6J-WJ67
  5. Federal Bureau of Investigation, 2015 Crime in the United States, https://perma.cc/EP6K-QXPD.
  6. National Center on Addiction and Substance Abuse at Columbia University (CASA), Behind Bars II: Substance Abuse and America’s Prison Population (New York: CASA, 2010).
  7. Joanne Csete et al., “Public Health and International Drug Policy,” The Lancet 387, no. 10026 (2016): 1427-1480; Global Commission on Drug Policy, The Negative Impact of the War on Drugs on Public Health: The Hidden Hepatitis C Epidemic, May 2013, https://perma.cc/2LTD-BQZX; and Ernest Drucker, “Drug Prohibition and Public Health: 25 Years of Evidence,” Public Health Reports 114, no. 1 (1999): 14-29. 
  8. There are various—and often overlapping—ways to describe the emerging set of approaches for responding to drug use across intercepts in the criminal justice system. These include the “four-pillar approach” and the “public health approach to drug use.” See, for example, Donald MacPherson, A Framework for Action: A Four-Pillar Approach to Drug Problems in Vancouver, (City of Vancouver: April 24, 2014), https://perma.cc/5AZ3-SLBV; American Public Health Association, Defining and Implementing a Public Health Approach to Drug Use and Misuse, Policy Statement Number 201312, November 5, 2013, https://perma.cc/7SMX-UGXQ; and Tracy Pugh et al., Blueprint for a Public Health and Safety Approach to Drug Policy (New York: New York Academy of Medicine and Drug Policy Alliance, 2013). 
  9. Safe Injections Facilities (SIFs) are a somewhat common harm reduction strategy in countries such as the Netherlands, Germany, Canada, and Norway. Several stakeholders in Ithaca, New York, including the mayor, have publicly announced plans to create a SIF, as part of their four-part plan to combat overdose. See City of Ithaca, The Ithaca Plan: A Public Health and Safety Approach to Drugs and Drug Policy, https://perma.cc/V25U-EFUM. However, this is not a tactic that has gained traction in most jurisdictions as it remains controversial. See, for example, William A. Jacobson, “Does Ithaca really need a government-run heroin shooting gallery?” Legal Insurrection, February 23, 2016, https://perma.cc/57HS-44MN.
  10. See the Lead National Support Bureau, http://www.leadbureau.org/
  11. Susan E. Collins, Heather S. Lonczak, and Seema L. Clifasefi, LEAD Program Evaluation: Recidivism Report (Seattle: University of Washington Harm Reduction Research and Treatment Center, 2015); Susan E. Collins et al., LEAD Program Evaluation: Criminal Justice and Legal System Utilization and Associated Costs (Seattle: University of Washington Harm Reduction Research and Treatment Center, 2015); and Susan E. Collins et al., LEAD Program Evaluation: The Impact of LEAD on Housing, Employment and Income/Benefits (Seattle: University of Washington Harm Reduction Research and Treatment Center, 2016). 
  12. Catherine Anne Fullerton et al., “Medication-Assisted Treatment with Methadone: Assessing the Evidence,” Psychiatric Services 65, no. 2 (2014): 146-157; Cindy Parks Thomas et al., “Medication-Assisted Treatment with Buprenorphine: Assessing the Evidence,” Psychiatric Services 65, no. 2 (2014): 158-170; and Timothy W. Kinlock et al., “A randomized clinical trial of methadone maintenance for prisoners: Results at 12 months post-release,” Journal of Substance Abuse Treatment 37, no. 3 (2009): 277-285. 
  13. Harlan Matusow et al., “Medication Assisted Treatment in U.S. Drug Courts: Results from a Nationwide Survey of Availability, Barriers and Attitudes,” Journal of Substance Abuse Treatment 44, no. 5 (2013): 473-480. 
  14. Amy Nunn et al., “Methadone and Buprenorphine Prescribing and Referral Practices in U.S. Prison Systems: Results from a Nationwide Survey,” Drug and Alcohol Dependence 105 (2011): 83-88.
  15. New Jersey S2381 (2015); New York AB 6255 (2015); Indiana HB 1304 (2015); and West Virginia HB 2880 (2015).
  16. Sally Friedman and Kate Wagner-Goldstein, Medication Assisted Treatment in Drug Courts: Recommended Strategies (New York: Center for Court Innovation, 2015). 
  17. Since 2008, the Harm Reduction Coalition has maintained a database of organizations providing naloxone kits to laypersons; Eliza Wheeler et al., “Opioid Overdose Prevention Programs Providing Naloxone to Laypersons—United States, 2014,” Morbidity and Mortality Weekly Report 64, no. 23 (2015): 631-635. 
  18. A corresponding trend is for jurisdictions to pass “Good Samaritan” laws that encourage bystanders to summon emergency responders in the event of an overdose without fear of arrest or other negative legal consequences. See The Network for Public Health Law, Legal Interventions to Reduce Mortality: Naloxone Access and Overdose Good Samaritan Laws (St. Paul, MN: The Network for Public Health Law, 2016), https://perma.cc/4PUG-HTHZ; and Rebecca Silber, Ram Subramanian, and Maia Spotts, Justice in Review: New Trends in State Sentencing and Corrections 2014-2015 (New York: Vera Institute of Justice, 2016). 
  19. North Carolina Harm Reduction Coalition, “Law Enforcement Carrying Naloxone,” https://perma.cc/69T5-58GM. There is also increased federal support for law enforcement agencies to establish naloxone programs. See, for example, National Training and Technical Assistance Center, Bureau of Justice Assistance, “Law Enforcement Naloxone Toolkit,” https://perma.cc/B4RW-F4FW
  20. Ingrid A. Binswanger et al., “Release from Prison – A High Risk of Death for Former Inmates.” New England Journal of Medicine 356 (2007): 157-165; and World Health Organization, Preventing overdose deaths in the criminal-justice system (Copenhagen, Denmark: World Health Organization, 2014).
  21. National Commission on Correctional Healthcare, Position Statement: Naloxone in Correctional Facilities for the Prevention of Opioid Overdose Deaths (Chicago: NCCH, 2015); North Carolina Harm Reduction Coalition, “Durham Jail First in South to Provide Naloxone to Released Inmates,” May 22, 2015, https://perma.cc/Z9RX-TAFC; Lauren Enteen et al., “Overdose Prevention and Naloxone Prescription for Opioid Users in San Francisco,” Journal of Urban Health 87, no. 6 (2010): 931-941; Howard Zucker et al., “Overdose Prevention for Prisoners in New York: A Novel Program and Collaboration,” Harm Reduction Journal 12 (2015): 51; and Traci C. Green et al., “Two cases of intranasal naloxone self-administration in opioid overdose,” Substance Abuse 35, no. 2 (2014):129-132.
  22. World Health Organization, Effectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS Among Injection Drug Users (Geneva: World Health Organization, 2004); and American Foundation for Aids Research (amfAR), “Syringe Services Program Coverage in the United States – June 2014,” https://perma.cc/8W9N-67AN
  23. David Cloud and Chelsea Davis, First Do No Harm: Advancing Public Health in Policing Practices (New York: Vera Institute of Justice, 2015). 
  24. As of July 2016, 46 out of 50 jurisdictions had naloxone access laws passed. See Law Atlas, Naloxone Overdose Prevention Laws Map, https://perma.cc/S2JE-QD27.
  25. A review of the literature on liability around naloxone administration suggests that the risk for a law enforcement officer or their employer is low. In nearly all states, laws exist that specifically provide extra liability protections for law enforcement officers. Furthermore, the majority of the states that now have naloxone access laws provide for civil and criminal immunity for any person administering naloxone in good faith. See Law Atlas, “Naloxone Overdose Prevention Laws” map, https://perma.cc/D7ST-DMUQ; and Bureau of Justice Assistance, Law Enforcement Naloxone Toolkit, https://perma.cc/MQW5-K4LL.
  26. Nancy Worthington et al., “Opiate Users’ Knowledge About Overdose Prevention and Naloxone in New York City: A Focus Group Study,” Harm Reduction Journal 3, no. 1 (2006): 19-26; and Michael A. Yokell et al., “Opioid Overdose Prevention and Naloxone Distribution in Rhode Island,” Medicine and Health, Rhode Island 94, no. 8 (2011): 240-242. 
  27. Peter D. Friedmann, Faye S. Taxman, and Craig E. Henderson, "Evidence-based treatment practices for drug-involved adults in the criminal justice system," Journal of Substance Abuse Treatment 32, no. 3 (2007): 267-277; and Peter D. Friedmann et al., "Medication-assisted treatment in criminal justice agencies affiliated with the criminal justice-drug abuse treatment studies (CJ-DATS): availability, barriers, and intentions," Substance Abuse 33, no. 1 (2012): 9-18. To address these concerns, jail administrators can partner with community harm reduction organizations and local health departments to plan and implement overdose education and prevention programs. For example, the Harm Reduction Coalition has developed a manual to assist local leaders working to get programs off the ground. See Eliza Wheeler et al., Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects (New York: Harm Reduction Coalition, 2012). 
  28. Christine Vestal, “At Rikers Island, a Legacy of Medication-Assisted Opioid Treatment,” The Pew Charitable Trusts, May 23, 2016, https://perma.cc/NRY7-TRZ4.
  29. Although a full examination of the changing demographics of overdose deaths is beyond the scope of this paper, it is relevant to note that the conversation around treatment-oriented solutions to the opioid epidemic has expanded at the same time that the epidemic has impacted more white people from rural and suburban communities. From 1999 to 2014, the rate of overdose for white people ages 25 to 34 increased fivefold, and tripled among those 35 to 44 years old. See Gina Kolata and Sara Cohen, “Drug Overdoses Propel Rise in Mortality Rates of Young Whites,” The New York Times, January 16, 2016, http://www.nytimes.com/2016/01/17/science/drug-overdoses-propel-rise-in-mortality-rates-of-young-whites.html.
  30. For example, as an evidence-based approach, medication-assisted treatment resonates with people who understand addiction as a disease. Because MAT has been shown to be associated with reduced recidivism, it can also appeal to stakeholders who are primarily concerned with improving public safety and reducing costs. See Amy Nunn et al., 2011; and Nicole Egli et al., “Effects of Drug Substitution Programs on Offending among Drug-Addictions: A Systematic Review,” Campbell Systematic Reviews 5, no. 3 (2009).