Engagement with overdose education and naloxone uptake at jail release: Evidence from a vending machine-based naloxone-on-release program in Los Angeles County.

Abstract

Individuals released from incarceration face substantially elevated risk of opioid-related overdose, particularly in the immediate post-release period. Naloxone-on-release programs, including vending machine-based distribution models, have expanded in carceral settings; however, limited evidence exists regarding factors associated with overdose education engagement and naloxone uptake at release. We examined these factors within a jail-based naloxone-on-release program in the Los Angeles County Jail system. Using time-location sampling in jail release areas (December 2022-December 2025), 528 justice-involved adults enrolled in a longitudinal cohort completed a baseline survey at release. Measures assessed viewing of an overdose education video, naloxone uptake from a no-cost vending machine, and participant characteristics. Bivariate and stratified chi-square analyses examined correlates of video engagement and naloxone uptake. Nineteen percent of participants reported taking naloxone from the vending machine at release. Twenty-seven percent reported viewing the overdose education video. Naloxone uptake was associated with select substance use and overdose history variables (p < 0.05), but did not differ by race or gender. Video engagement was associated with gender and length of incarceration, but not with substance use or overdose history. No overall association was observed between video viewing and naloxone uptake; exploratory analyses suggested moderation by substance use history. Findings support the feasibility of jail-based vending machines as a low-barrier implementation strategy for naloxone-on-release among individuals at highest risk for experiencing or witnessing an opioid-related overdose. Limited engagement with passive video-based education highlights opportunities to strengthen overdose education delivery within release settings.