Effectiveness, acceptability, and feasibility of naloxone in carceral settings: a scoping review.

BACKGROUND

Opioid dependence is highly prevalent within incarcerated populations, with one-fifth of all drug overdose deaths occurring among formerly incarcerated individuals. Opioid antagonists are promising in reversing overdoses, with naloxone widely recognised as a rapid and safe treatment for opioid toxicity. While community-based evidence demonstrates the efficacy of naloxone in reducing overdose deaths, its implementation in carceral settings is neither standardised nor embedded.

OBJECTIVE

This scoping review aims to systematically assess the acceptability, feasibility, and effectiveness of naloxone interventions in prisons and other detention settings globally, with the explicit goal of identifying research gaps and generating evidence to inform global prison policy, practice and future implementation research.

METHODS

A scoping review was conducted following Arksey and O'Malley's framework. Literature searches were performed in PubMed, Scopus, and Embase for English-language records published between 2000 and 2025, in line with the PRISMA Extension for Scoping Reviews guidelines. Data were analysed using narrative synthesis as informed by Popay et al.

RESULTS

Of the 1764 records initially identified, 24 records met the inclusion criteria. Three themes and associated sub-themes were identified. They were (a) current provision (naloxone distribution and benefits; Take-Home Naloxone programmes on community release; naloxone (intranasal) within carceral settings; rollout of naloxone vending machines), (b) population satisfaction (acceptability and feasibility; implementation readiness) and (c) organisational factors (barriers and challenges; facilitators and suggestions).

CONCLUSION

Naloxone provision in carceral settings is acceptable, feasible, and effective in preventing opioid overdoses during incarceration and after release. Strong support exists among prisoners and staff, yet significant gaps remain, particularly regarding use in vulnerable populations such as women, younger individuals, and immigration detainees. Integrating naloxone into prison health systems, alongside staff training and peer engagement, is a critical step in reducing preventable overdose deaths and enhancing continuity of care post-release.