Rural Opioid Harm Reduction for Justice-Involved Individuals

This project serves rural Georgia counties with a population of less than 50,000. Please review the Georgia Department of Community Health’s Georgia Rural Counties Map.

Harm reduction is a public health approach that focuses on minimizing the negative consequences of certain behaviors, especially those considered risky, without necessarily requiring people to stop the behavior altogether. Opioid harm reduction focuses on reducing overdose deaths. It refers to strategies, programs, and policies aimed at minimizing the negative health and social effects of opioid use. The focus is on safety, dignity, and improving overall well-being, especially for people who use opioids.

Opioids are a class of natural, semi-synthetic, and synthetic drugs. These include both prescription medications used to treat pain, such as oxycodone, hydrocodone, morphine, and codeine, and non-prescription drugs like heroin and fentanyl. Opioids are highly addictive. Use of opioids, either by themselves or in combination with other drugs, is a major driver of the drug overdose crisis in the United States.

Learn more about about opioids.

Signs of an opioid overdose include a variety of symptoms such as: unconsciousness, very small pupils, slow or shallow breathing, vomiting, an inability to speak, faint heartbeat, limp arms and legs, and discolored skin (especially in nails or lips).

Call 911

Administer Naloxone (Narcan)

Naloxone won’t harm someone if they’re overdosing on drugs other than opioids, so it’s always best to use it if you think someone is overdosing. Keep the person awake and breathing. Lay the person on their side to prevent choking. Stay with the person until help arrives.

• Naloxone is a life-saving medication that can reverse an overdose from opioids, including What is naloxone (Narcan)?heroin, fentanyl, and prescription opioid medications. You might know it by the brand name Narcan. 
• Naloxone quickly reverses an overdose by blocking the effects of opioids. It can restore normal breathing within 2 to 3 minutes in a person whose breath has slowed, or even stopped, as a result of opioid overdose.
• There are two types of naloxone: pre-filled nasal spray and injectable. The most common is a nasal spray, which is a prefilled device that sprays naloxone into the nose.

Start by administering one dose of naloxone in the dose and wait 2-3 minutes to see if normal breathing returns before giving a second dose. Naloxone won’t harm someone if they’re overdosing on drugs other than opioids, so it’s always best to use it if you think someone is overdosing. If you give someone naloxone, stay with them until emergency help arrives. Watch this video on how to administer naloxone.

Start by administering one dose of naloxone and wait 2-3 minutes to see if normal breathing returns before giving a second dose. If they don’t respond, you should give another dose after 2–3 minutes and continue rescue breathing if needed. Additional doses may be needed.

After administering naloxone, the person may start breathing again within 2–3 minutes but could wake up confused, upset, or in withdrawal, experiencing symptoms like nausea, sweating, or agitation. If they don’t respond, you should give another dose after 2–3 minutes and continue rescue breathing if needed. Always call 911, as naloxone wears off in 30–90 minutes, and the person could overdose again if opioids are still in their system. Stay with them until emergency help arrives.

Naloxone may cause withdrawal symptoms or unpleasant physical reactions in people who are physically dependent on opioids. Withdrawal symptoms may include fever, anxiety, irritability, rapid heart rate, sweating, nausea, vomiting, and tremors.

Naloxone won’t harm someone if they’re overdosing on opioids or other drugs, so it’s always best to use it if you think someone is overdosing. Naloxone is not addictive.

• Naloxone is available in all 50 states and at pharmacies in Georgia without a prescription. 
• Request a naloxone kit
• Get naloxone mailed to you
• Georgia naloxone distribution access points
• Standing order for prescription of naloxone for overdose prevention

This law protects people who call 911 during an overdose. If you stay at the scene and seek help, you (or the victim) can’t be arrested, charged, or prosecuted for small amounts of drugs or paraphernalia.

Justice-involved individuals are people who have had direct contact with the criminal legal system, including those who are currently or formerly incarcerated, on probation or parole, or involved in pretrial or diversion programs. Justice-impacted individuals include not only the justice-involved, but also their families, loved ones, and communities affected by incarceration, policing, or criminal justice practices.

Approximately 1.2 million people are currently in U.S. prisons, and over 400,000 are released each year (Carson & Kluckow, 2023). Nearly two-thirds of incarcerated adults have a diagnosed substance use disorder (Bronson et al., 2017). 

Despite this impact, many correctional systems lack sufficient response options. Given the high number of individuals with substance use disorders, such as opioid use disorder, who come into contact with the justice system, correctional facilities present a vital opportunity for intervention, harm reduction, and support.

The days and weeks right after release from jail are some of the most dangerous times for people with a history of substance use. Research shows that the risk of overdose death is an estimated 40-120x higher in the first two weeks after release compared to the general public (Binswanger et al., 2007). This increase in risk is caused by lowered drug tolerance, lack of ongoing care, and limited access to support services.