Fentanyl-related overdose during incarceration: a comprehensive review

Introduction

Opioid use and incarceration are interrelated problems in the United States. Even prior to the current opioid-driven overdose epidemic, up to one-third of people who used heroin were incarcerated annually (Boutwell, Nijhawan, Zaller, & Rich, 2007). Opioid use disorder (OUD) is more severe and advanced in justice-involved populations than in the general population (Winkelman, Chang, & Binswanger, 2018). While incarcerated, individuals often undergo a period of reduced opioid use that may lead to a diminished physiological tolerance to opioids (Binswanger et al., 2007). Reduced tolerance has been identified as a significant contributor to risk for drug overdose following release from incarceration, and it is estimated that individuals released from incarceration have nearly 13 times the risk of death as the general population, with overdose as the leading cause (Binswanger et al., 2016; Brinkley-Rubinstein et al., 2018; Green et al., 2018).

Fentanyl and related compounds have recently emerged as the primary drivers of the opioid overdose epidemic in the United States, having saturated much of the illicit drugs (Increases in Fentanyl Drug Confiscations and Fentanyl-Related Overdose Fatalities, 2018; O’Donnell, Halpin, Mattson, Goldberger, & Gladden, 2017; Ostling et al., 2018; Reported Law Enforcement Encounters Testing Positive for Fentanyl Increase Across US | Drug Overdose | CDC Injury Center, 2019; U.S. Drug Overdose Deaths Continue to Rise; Increase Fueled by Synthetic Opioids, 2019). As evidenced by toxicology reports and personal accounts from people who use illicit substances, illicit fentanyl is often mixed with heroin—although it has also recently been detected in cocaine and counterfeit opioid and benzodiazepine pills (Carroll, Marshall, Rich, & Green, 2017; Ciccarone, Ondocsin, & Mars, 2017; Korte, 2018; Suzuki & El-Haddad, 2017). Due to its lipophilic properties, fentanyl rapidly crosses the blood-brain barrier and binds to opioid receptors (Suzuki & El-Haddad, 2017). Estimated to be between 30 to 50 times more potent than heroin and 50 to 100 times more potent than morphine, fentanyl poses a much higher risk of overdose, even to those exposed to very small quantities (Ciccarone et al., 2017; Suzuki & El-Haddad, 2017).

In response to the worsening overdose crisis, policymakers and public health and medical institutions have launched initiatives to increase awareness of the risk and ubiquity of illicitly manufactured fentanyl in the community (U.S. Drug Overdose Deaths Continue to Rise; Increase Fueled by Synthetic Opioids, 2019). These efforts have primarily focused on promoting rigorously tested harm reduction measures, including education, naloxone distribution and access to low-barrier medication for opioid use disorder (MOUD) (Facing Addiction in America: The Surgeon General’s Spotlight on Opioids, 2019). Naloxone is a fast-acting opioid antagonist that blocks the effects of opioids and can thus reverse opioid overdose. While the number of MOUD programs increase, and access to naloxone continues to expand in the United States to include first responders, lay people, and individuals who are at risk for overdose in the community, to date these efforts have been limited in correctional facilities (Horton et al., 2017; Kim, Irwin, & Khoshnood, 2009; Wenger et al., 2019).

Correctional systems utilize intense surveillance, sanction and control to prevent illicit substances from entering into facilities (Kolind & Duke, 2016). Despite these efforts, nearly all correctional facilities have ongoing problems with contraband, ranging from cell phones to illicit substances (Kolind & Duke, 2016). Illicit fentanyl is inexpensive, widely available, and easy to smuggle into facilities to due to its high potency and need for only very small amounts (Increases in Fentanyl Drug Confiscations and Fentanyl-Related Overdose Fatalities, 2018; O’Donnell et al., 2017; Ostling et al., 2018; Reported Law Enforcement Encounters Testing Positive for Fentanyl Increase Across US | Drug Overdose | CDC Injury Center, 2019;U.S. Drug Overdose Deaths Continue to Rise; Increase Fueled by Synthetic Opioids, 2019). People who are incarcerated are at an increased risk of overdose when exposed to fentanyl, due to its high potency and the lower tolerance levels resulting from decreased opioid use while incarcerated.

The present study

There are many causes of mortality in incarcerated populations including fatal drug overdose risk immediately following release, natural deaths, and intentional deaths during incarceration, including suicide on-site (Arfken, Suchanek, & Greenwald, 2017; Fazel & Benning, 2006; Kim et al., 2007; Larney, Topp, Indig, O’Driscoll, & Greenberg, 2012; Larney et al., 2014; Larney & Farrell, 2017; Mumola, n.d.; Salive, Smith, & Brewer, 1990). However, few studies have explored fentanyl-related overdose events in jails and prisons (Larney et al., 2014). Given the current fentanyl-driven overdose epidemic in the community and the presence of contraband drugs in correctional facilities, it is likely that there are fentanyl-related overdose deaths among individuals who are incarcerated. To better understand this, we conducted a comprehensive review of published reports of fentanyl-related overdose in correctional facilities, including jails and prisons. We aim to use our findings to gain a better understanding of the prevalence of fentanyl overdoses in prisons and jails in the United States to ultimately to reduce those overdoses and deaths.

Methods

In this comprehensive review, we examined fentanyl-related overdose events during incarceration in a jail or prison. We defined a fentanyl-related overdose event as the occurrence of at least one fentanyl-related overdose on a given day at a correctional facility. Thus, one overdose event may involve multiple overdose victims. Fentanyl-related overdoses that occurred at the same correctional facility but on separate days were not defined as one overdose event; rather overdoses on each individual day comprised unique events. We defined a fentanyl-related overdose as a fatal or non-fatal overdose that was either confirmed or suspected to involve fentanyl, as stated by the source.

We systematically reviewed the medical literature for reports of fentanyl-related overdose events during incarceration from January 1, 2013 to March 30, 2021. PubMed and PsycINFO were used to identify reports in the medical literature. We reviewed articles published using the search terms: (“fentanyl overdose”) AND (prison OR jail).

Due to the fact that we found no cases in the peer-review literature, we expanded our search to include the lay press. Google search engine and Google alerts were used to identify cases of overdose in the media and lay press from January 1, 2013 to March 30, 2021. We used the same search terms, “fentanyl overdose in prison” and “fentanyl overdose in jail,” in the Google search engine. Our results yielded local and national news articles, blogs, and press releases. All results were manually reviewed and examined until we reached a full page of search results that contained no articles relevant to the review. For each reported fentanyl overdose event identified, an additional Google search was initiated using details of the event as search terms, such as the name of the correctional facility or the overdose victim. All relevant articles and details of the overdose events were cataloged and collated.

Results

Not a single instance of fentanyl-related overdose reports or scientific articles among incarcerated individuals was identified through PubMed or PsycINFO. Our media analysis and search of articles in the lay press returned 113 relevant reports. After duplicate reports were combined, our results identified a total of 90 reported events comprising 179 fentanyl-related overdoses during the study period. Of these 179 fentanyl-related overdoses, 76 were fatal and 103 were nonfatal. One victim overdosed twice on different days (Hopkins, 2017). All United States regions were represented; specifically, reported overdose events occurred across 32 states and the District of Columbia (DC). California, Florida, Pennsylvania and Ohio were overrepresented with a total of 40, 18, 11, and 10 overdoses, respectively. Of note, 13 of the 40 overdoses in California resulted from a single events at the Mule Creek State Prison in April 2018 (Goldberg, 2018). Based on the U.S. Department of Agriculture’s Rural-Urban classification scheme (USDA ERS - Rural-Urban Continuum Codes, n.d.), 72 overdose events occurred in metropolitan counties, 17 events occurred in nonmetropolitan countries with urban populations, and 1 event occurred in Washington, DC. Characteristics of the known and suspected fentanyl overdose cases among incarcerated individuals are presented in Table 1.

Table 2 presents the breakdown of fatal and non-fatal overdoses in prisons and jails, and Fig. 1 presents overdoses in correctional settings over time.

Confirmation of fentanyl

In 77% (n = 70) of included events, the involvement of fentanyl or its analogs was reported by the source. However, only a few overdose events (n = 12) were reported to include a systematic toxicology screening upon overdose. Most articles did not specify whether exposure to fentanyl was intentional or unintentional. During an overdose event in Covington, Kentucky on September 4, 2016, a young woman at the Kenton County Jail unintentionally consumed fentanyl and died of a fatal overdose (Crittenden Woman Sentenced to 224 Months for Distribution of Drugs Resulting in Death, 2016). Toxicology reports revealed a mixture of fentanyl and morphine in her body at the time of death; however, both her mother—who delivered the substance through two individuals who were incarcerated at the jail—and the individual her mother purchased the substance from believed it to be heroin (Crittenden Woman Sentenced to 224 Months for Distribution of Drugs Resulting in Death, 2016).

Fentanyl entrance

In outlining the circumstances around the fentanyl-related overdose events, 33 (37%) reports also described how fentanyl entered the correctional facility. Purported modes of entry included being smuggled in by a family member, a food service employee, a visitor during an open house, and an individual who was incarcerated and hid a bag of fentanyl inside her body. Many of the reports in the lay press emphasized the tight surveillance and security measures within correctional settings.

Response to overdose

Naloxone was administered to overdose victims in 20 (22%) events, one of which occurred in 2015 and the remainder of which occurred between 2017 and 2021. While naloxone was administered either by correctional or medical staff, individuals who were incarcerated played a critical role in response to overdoses in a couple of instances, such as when they notified correctional staff at the Lorain County Jail in Elyria, Ohio about an individual who was incarcerated who was overdosing (Sandy, 2016). In another instance from May 2014, individuals who were incarcerated at the Henrico County Jail in Henrico, Virginia applied ice on parts of the victim’s body in attempts to revive him after he overdosed, which is an ineffective method to reverse opioid overdose (McKelway, 2015). The overdose accounts included in this review demonstrate how the onset of fentanyl-related overdose symptoms is rapid. In an article describing a fatal overdose at the Baltimore Central Booking and Intake Center in June 2018, a victim’s health is described as having deteriorated rapidly after ingesting what was later confirmed to be a mixture of morphine and fentanyl. Less than an hour prior to overdosing, he was described as “cool, calm, relaxed” (Bogel-Burroughs, 2018). In another fatal overdose case, an individual who was incarcerated died on June 28, 2015 while in police custody at the Gunnison County Jail in Gunnison, Colorado. A check performed at 9:01 am did not raise concerns about his health. However, he was found unconscious 3 minutes later (Michell, 2016).

Discussion

This is the first paper to summarize fentanyl-related overdose events that occurred during incarceration. No reports were identified in the medical literature. However, we identified 90 overdose events totaling 179 overdoses in the lay press and these reports are rapidly increasing. The large discrepancies in reporting between the lay press and the medical literature suggests under-reporting of overdose events in prisons and jails, and a lack of attention given to the opioid crisis in correctional settings more generally. The number of fentanyl overdoses is likely much higher, as in an article published in the Orange County Register, a sheriff reported that 129 doses of naloxone had been administered to 70 individuals in 2019 (Saavedra, 2020), and yet, our media search revealed only a single reported overdose event in Orange County that year (OC Inmate’s Death Caused By Fentanyl Overdose, Officials Say, 2020). This suggests a vast under reporting of overdoses, and likely fentanyl overdoses in prisons and jails. We suspect that correctional administrators endure tremendous pressure to minimize the prevalence of substances and contraband inside, in an effort to maintain the perception that jails are safe and rehabilitative. For example, our team is anecdotally aware of six events of fentanyl related overdoses and deaths, that occurred in correctional facilities in two different states where the attending clinicians were told by their superiors not to report these cases in the medical literature.

As fentanyl contamination of the drug supply continues in the community, we expect its presence in correctional facilities to likewise rise in parallel. However, the scope of the problem is unclear because fentanyl overdoses in correctional facilities are not being systematically tracked. Unfortunately, as demonstrated by the few reports of systematic toxicology screening in our study, there currently is no standard of care for evaluating deaths among people who were incarcerated; ideally, an autopsy and complete toxicologic screening should be completed for all deaths occurring in correctional facilities. Enforcing a standard of care for all deaths and a system to systematically track deaths in correctional settings is essential to fully understanding the scope of the crisis.

However, further data is not necessary to begin addressing overdoses and deaths in corrections. Three evidence-based interventions can, and must, be implemented 1) educate correctional staff and individuals who are incarcerated about the risks of fentanyl, 2) ensure widespread, readily available naloxone accompanied with training on how to properly administer it, and 3) expand availability of medications for opioid use disorder in prisons and jails.

Our study found that naloxone was reported to be administered in only 22% of included overdose events. Both correctional staff and individuals who are incarcerated should be educated on the growing prominence of fentanyl, its effects, signs of an opioid overdose, and the use of naloxone. As a harm reduction measure, naloxone trainings should be widely available to all staff and individuals who are incarcerated. Studies of naloxone training in the correctional setting underscore the potential for individuals who are incarcerated to participate in trainings and correctly administer intranasal naloxone while incarcerated (Green, Ray, Bowman, McKenzie, & Rich, 2014; Kobayashi et al., 2017; Parmar, Strang, Choo, Meade, & Bird, 2017; Petterson & Madah-Amiri, 2017). At a minimum, naloxone should be present in all correctional units, and units should be staffed with correctional officers who are trained in naloxone administration. As of November 2018, RIDOC implemented the first statewide naloxone training for correctional officers, which included trainings to recognize overdose symptoms and correctly administer naloxone. Naloxone is now offered to RIDOC officers who completed the training and is readily available in all Rhode Island prisons (personal communication Jennifer Clarke, MD, MPH).

In addition to naloxone distribution, MOUD remain the gold-standard of treatment for OUD and an effective harm-reduction intervention to prevent overdose (Facing Addiction in America: The Surgeon General’s Spotlight on Opioids, 2019). The availability of and attitudes toward MOUD in correctional facilities are rapidly changing given the magnitude of the epidemic and the demonstrated decrease in overdose deaths among individuals recently released from incarceration. In a randomized clinical trial conducted by Kinlock and Gordon et al. in Baltimore, Maryland, participants who were incarcerated and assigned to receive both counseling and methadone were less likely to test positive for opioids at one-, three-, six-, and twelve-month follow-ups in the community compared to those who received only counseling (Kinlock et al., 2007; Kinlock, Gordon, Schwartz, Fitzgerald, & O’Grady, 2009; Kinlock, Gordon, Schwartz, & O’Grady, 2008). Our team has also demonstrated that individuals who are maintained on methadone while incarcerated are more likely to return to their methadone clinic after they are released than those who undergo forced withdrawal while incarcerated (Rich et al., 2015). Thus, not only does providing access to MOUD in corrections increase individual’s chance of recovery upon reentry, it also reduces risk of overdose during and after incarceration. Despite the robust literature demonstrating its efficacy, the use of MOUD in correctional facilities is still met with resistance. According to the Jail and Prison Opioid Project (JPOP), only 356 correctional facilities out of the nearly 5000 facilities in the United States offer any form of MOUD to individual who are incarcerated (Prison Opioid Project – Medication for Opioid Use Disorder and the Criminal Justice System, n.d.).The compounded problem of extremely concentrated, widely available and affordable fentanyl, and the lowered tolerance of individuals during incarceration, necessitates evidence-based interventions. Generally, there has been a lack of response among correctional facilities to address the growing opioid crisis; our study found that among the facilities that have attempted to respond to the overdose crisis, they have predominantly done so through increasing security and surveillance. However, a recent study found that increased surveillance and punishment among people using opioids was correlated to less likelihood to seek treatment and begin recovery (Mazhnaya et al., 2016). Harm-reduction interventions in the community have effectively reduced risk of overdose; however, there has been little focus on promoting these in criminal justice settings as well.

Our findings should be interpreted in light of several limitations. To our knowledge, no scientific papers about fentanyl overdose during incarceration have been published, and cases reported in the lay press likely represent only a fraction of all overdose events. Moreover, due to the 2019 novel coronavirus (COVID-19) pandemic, media coverage on correctional facilities has likely shifted towards COVID-19 outbreaks in facilities and away from fentanyl-related overdoses. Reluctance to release data on overdose within corrections likely also results in the underreporting of fentanyl-related overdoses. More systematic data collection, reporting, and surveillance of unintentional drug-induced deaths is needed to understand the magnitude of fatal and nonfatal fentanyl-related overdoses in the incarcerated population.

Conclusions

Fentanyl-related overdoses in correctional facilities are likely spill-over from the opioid epidemic in the community. Fear and misinformation around fentanyl exposure have contributed to the stigmatization of OUD and resistance towards effective harm reduction measures and treatment. Illicit drug use in correctional facilities occurs regularly. In the face of this evolving fentanyl-driven opioid epidemic, correctional staff, individuals who are incarcerated, and the public must be equipped with the knowledge and tools necessary to reduce and prevent fatal and nonfatal overdose events. Naloxone and MOUD, specifically, are beneficial after release and should also be safe and effective in jails and prisons. Moreover, systematic data collection, including toxicology screens, and increased reporting of fatalities in corrections are urgently needed to monitor and curb the opioid overdose epidemic.

Summary

This study reviews fentanyl-related overdoses within US correctional facilities. A significant correlation exists between opioid use and incarceration. Individuals with opioid use disorder (OUD) in the justice system exhibit more severe conditions than the general population. Incarceration leads to reduced opioid use, subsequently decreasing physiological tolerance. This reduced tolerance significantly increases the risk of fatal overdose upon release. Fentanyl's high potency and prevalence in illicit drug markets exacerbate this risk.

Methods

This comprehensive review examined fentanyl-related overdose events in US correctional facilities (jails and prisons) from January 1, 2013, to March 30, 2021. A fentanyl-related overdose event was defined as at least one such overdose occurring on a single day within a facility. The study employed a systematic review of the medical literature (PubMed, PsycINFO) using search terms “fentanyl overdose” AND (prison OR jail). Due to the absence of relevant peer-reviewed studies, the search expanded to include lay press sources (Google, Google Alerts).

Results

No fentanyl-related overdose reports were found in the medical literature. The lay press analysis yielded 90 reported events comprising 179 overdoses (76 fatal, 103 non-fatal). These events spanned 32 states and Washington D.C., with California, Florida, Pennsylvania, and Ohio showing a disproportionate number of cases. Fentanyl involvement was reported in 77% of events, though toxicology screenings were limited. Methods of fentanyl entry into facilities included smuggling by visitors or staff and internal concealment by inmates. Naloxone administration was reported in only 22% of events.

Discussion

The disparity between lay press reports and the medical literature strongly suggests significant underreporting of these events. The lack of systematic tracking and potential pressure to minimize negative perceptions of correctional facilities likely contribute to this underreporting. Given fentanyl's increasing community prevalence, its presence in correctional facilities is expected to rise. The study highlights the urgent need for standardized procedures for investigating deaths in correctional facilities, including mandatory autopsies and toxicology screenings.

The authors propose three evidence-based interventions: education on fentanyl risks for both staff and inmates, widespread naloxone availability and training, and expanded access to medication-assisted treatment (MAT) for opioid use disorder (OUD) within correctional settings. The efficacy of MAT in reducing overdose risk is well-established. However, significant resistance to its implementation persists in many correctional facilities. Increased surveillance and punitive measures have been shown to deter individuals from seeking treatment. The study concludes by emphasizing the necessity of systematic data collection and improved reporting to address this critical public health issue.

Conclusions

Fentanyl-related overdoses in correctional facilities reflect the broader opioid epidemic. Stigma and misinformation hinder the adoption of effective harm reduction strategies. Immediate action is needed, including improved data collection, widespread naloxone implementation, expanded access to MAT, and comprehensive education programs for all stakeholders. These interventions are crucial for curbing the opioid overdose crisis within correctional settings.

Summary

Opioid use disorder (OUD) is prevalent among incarcerated populations, often more severe than in the general population. Incarceration leads to periods of reduced opioid use, resulting in diminished tolerance. This significantly increases the risk of fatal overdose upon release. The current opioid crisis is largely driven by fentanyl, a highly potent synthetic opioid frequently mixed with other drugs. While harm reduction strategies like naloxone distribution and medication-assisted treatment (MAT) are expanding in the community, their implementation in correctional facilities lags significantly. This study examines fentanyl-related overdoses within correctional settings.

Methods

This review investigated fentanyl-related overdose events in jails and prisons from January 1, 2013, to March 30, 2021. Due to a lack of relevant peer-reviewed articles, the researchers expanded their search to include news articles and other media reports. A fentanyl-related overdose event was defined as one or more overdoses occurring on a single day at a correctional facility. Data collected included location, fatality, suspected method of fentanyl introduction into the facility, and responses to overdoses.

Results

The study identified 90 reported events involving 179 fentanyl-related overdoses (76 fatal, 103 non-fatal). These events were reported across 32 states and the District of Columbia, with California, Florida, Pennsylvania, and Ohio showing disproportionately high numbers. In 77% of events, fentanyl involvement was explicitly stated; however, systematic toxicology screenings were infrequent. The methods of fentanyl introduction varied, including smuggling by visitors or staff, and concealment by individuals who are incarcerated. Naloxone was administered in only 22% of the events. The rapid onset of symptoms was highlighted in several cases.

Discussion

The significant discrepancy between the lack of peer-reviewed articles and the substantial number of media reports suggests underreporting of fentanyl-related overdoses in correctional facilities. The researchers hypothesize that pressure to maintain a perception of safety within these facilities may contribute to this underreporting. The authors propose three key interventions: education on fentanyl risks and naloxone administration for both staff and individuals who are incarcerated, increased naloxone availability, and expanded access to medication-assisted treatment (MAT) for OUD within correctional facilities. They cite evidence supporting the effectiveness of MAT in reducing post-release opioid use and overdose risk. The study acknowledges limitations, including the reliance on media reports and the potential impact of the COVID-19 pandemic on reporting practices.

Conclusions

Fentanyl-related overdoses in correctional facilities represent a critical, yet under-recognized, aspect of the ongoing opioid crisis. Addressing this requires increased awareness, readily available naloxone, expansion of MAT programs, and systematic data collection to accurately assess the scope of the problem and inform effective interventions.

Summary

Opioid use and incarceration are linked. Justice-involved populations have more severe opioid use disorders (OUD) than the general population. Incarceration leads to reduced opioid use and lower tolerance, increasing overdose risk upon release. Fentanyl, a powerful opioid, is a major factor in the current overdose crisis. It's highly potent and frequently mixed with other drugs, increasing the likelihood of accidental overdose, even in small amounts.

The Current Situation

While harm reduction efforts like naloxone distribution and medication-assisted treatment (MAT) are increasing outside prisons, they're limited within correctional facilities. Despite strict security measures, fentanyl is smuggled into jails and prisons due to its potency and ease of concealment. individuals who are incarcerated are at high risk of overdose due to fentanyl's potency and their lowered tolerance from reduced opioid use while incarcerated.

The Study

This review examined reports of fentanyl-related overdoses in US correctional facilities from 2013-2021. A lack of peer-reviewed studies led researchers to analyze news reports and other media sources. The study found significant underreporting of fentanyl-related overdoses in correctional facilities.

Findings

The review found 90 reported overdose events (179 overdoses), with 76 fatal and 103 non-fatal. Fentanyl's presence was confirmed in 70% of events, but toxicology screenings were infrequent. Fentanyl entered facilities via various methods, including smuggling by visitors or staff. Naloxone was administered in only 22% of events, highlighting a need for wider availability and training. The rapid onset of fentanyl overdose symptoms was a recurring theme.

Discussion

The significant discrepancy between media reports and scientific literature indicates severe underreporting. Correctional facilities may downplay these events. As fentanyl's presence grows in the community, it's expected to increase in correctional facilities. Consistent toxicology screenings and systematic tracking of deaths in correctional settings are crucial.

Addressing the Problem

Three key interventions are suggested: educating staff and inmates about fentanyl risks; ensuring widespread naloxone access and training; and expanding access to medication-assisted treatment (MAT) for OUD within correctional facilities. While naloxone administration was infrequent in reported events, training programs exist and are effective. MAT is a proven effective harm reduction strategy, but remains underutilized in correctional settings. Increased surveillance and punishment have been shown to deter individuals from seeking help, necessitating the adoption of harm-reduction strategies.

Limitations and Conclusions

This review has limitations due to underreporting and reliance on media accounts. The COVID-19 pandemic may have affected reporting patterns. Systematic data collection and improved reporting are urgently needed to address the scope of the problem. Fentanyl-related overdoses in prisons are largely a result of the wider opioid epidemic. Addressing this requires education, naloxone availability, MAT expansion, and improved data collection in correctional settings.

Summary

Many people in jail or prison have problems with opioid drugs. Opioids like fentanyl are very strong and can easily cause an overdose, even a tiny amount. When people stop using opioids for a while, like when they're in jail, they become more sensitive to them. This makes them more likely to overdose when they start using again. Fentanyl is a big problem because it's powerful and often mixed with other drugs without people knowing.

The Problem

Fentanyl is a very strong drug that can cause death from overdose, even in small amounts. Because it’s so powerful and easy to hide, it gets smuggled into jails and prisons. People in jail often have less tolerance for drugs because they haven't been using them, making them even more vulnerable to fentanyl overdoses.

What Was Done

Researchers looked for information about fentanyl overdoses in jails and prisons. They didn't find much in official medical reports, but they did find many news stories about it. These stories showed that many people in jail have overdosed on fentanyl.

What Was Found

The researchers found lots of news reports about fentanyl overdoses in jails and prisons. Many of these were fatal. They found that fentanyl often gets into jails in hidden ways. Sometimes naloxone, a drug that can reverse an overdose, was used, but not often enough.

What It Means

This study shows that fentanyl overdoses are a serious problem in jails and prisons. It’s much bigger than official records show. To help, we need to teach people in jails and prisons about fentanyl, give them naloxone, and offer them treatment for opioid addiction. More careful tracking of overdoses is also needed.