At a glance
Los Angeles County is working to increase the number of naloxone access points located outside of courthouses. Community health workers staff access points and provide free naloxone to individuals and family members who need it. To ensure program success, these access points are low barrier—this means there are no eligibility requirements, no forms to complete, and no need to disclose personally identifying information.
The challenge
Substance use disorders are common among justice-involved populations and research has shown that drug overdose is the leading cause of death among people recently released from incarceration.1
Formerly incarcerated people are at highest risk for a fatal opioid overdose during the first two weeks post-release.2 Many barriers can prevent them from seeking the help they need, including not having health insurance and not having access to transportation.34 For individuals transitioning back into the community after incarceration, having immediate access to naloxone can be a critical part of their reentry plan because periods immediately following release, when a person's opioid tolerance is low, are especially dangerous.5 Based on this and other local data, the LA County Department of Health Services is prioritizing naloxone distribution to areas with the greatest need.
The intervention
Naloxone education and distribution programs can be geared towards people who are about to be released from criminal justice or treatment facilities (both inpatient and outpatient). Before they exit from the program or facility, individuals receive overdose response training and naloxone take-home kits. Naloxone education and distribution programs within treatment and correctional settings are an effective way to train and equip this high-risk group—as well as their loved ones—with life-saving naloxone.
Pomona is on the eastern border of LA County and has limited access to community-based overdose prevention services including resources like naloxone and linkage to evidence-based treatment for opioid use disorder. LA County set up a new naloxone access point outside the Pomona library, located directly across from the Pomona Superior and LA Superior courthouses. LA County's creativity in developing this partnership with a public library highlights the resourcefulness required of OD2A: LOCAL-funded recipients to ensure community members get the support they need as quickly as possible.
Earlier this year, we learned that basic care resources (e.g., food banks, showers, laundry) for people experiencing homelessness were limited and resources like naloxone were even more scarce in the area. We also learned that many folks released from jail in Pomona are not from the area and often have a hard time navigating their first few days in a city with limited resources. The library access point is one of several efforts taken in response to the findings in this listening session.
- Jessica Reyes, MPH, Program Manager, LA County Department of Health Services
Identifying partners who are willing and able to champion community interventions for overdose prevention is no small feat. For this site launch, LA County worked with Pomona Library Director, Anita Torres. She describes the flow of people recently released from the courthouse to the library as a waiting area, or place to seek resources as they "get their bearings." She shared that many people released from jail in Pomona are not from the area and stay around the library until their ride arrives or until they have a plan for where to go and how they will get there.
The results to date
By setting up a naloxone access point outside of a library that is adjacent to and across from superior courthouses, LA County can effectively reach individuals transitioning back into the community. Libraries are often seen as safe spaces and can provide easy access for individuals who may be hesitant to seek help elsewhere. Since the access point is outside of the library, it is visible to people leaving the courthouse. Signage in the courtyard, outside of the court building, and inside the library also directs people to these services.
People began using this service on the first day it became available, October 10, 2024. During the month of February 2025, the team had 169 encounters at the Pomona naloxone access point, distributed 369 naloxone kits (containing 2 doses per box), and provided numerous referrals to support services. Since City Hall approved the program, the team has been able to try out different positions for setup in the courtyard between the library, City Hall, and the courthouse, highlighting the significance of this partnership and support.
When Ms. Reyes was asked whether she was concerned about community perceptions of a naloxone access point in a public library, she said, "By increasing the availability of naloxone in communities most vulnerable to overdose, we shift the perception of overdose as being like any other medical emergency. Library distribution outside of courthouses makes it clear that naloxone is a good resource for anyone to carry. Overdose education and naloxone distribution programs distribute naloxone along with other essential supplies. Staff also provide brief education on the use of naloxone and empower folks in the community with information regarding overdose response."
LA County plans to open two more naloxone access points near courthouses soon.
- Mital S, Wolff J, Carroll JJ. The relationship between incarceration history and overdose in North America: A scoping review of the evidence. Drug and alcohol dependence. 2020 Aug 1;213:108088
- Binswanger IA, Blatchford PJ, Mueller SR, Stern MF. Mortality after prison release: opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009. Ann Intern Med. 2013 Nov 5;159(9):592-600
- Joudrey PJ, Khan MR, Wang EA, Scheidell JD, Edelman EJ, McInnes DK, Fox AD. A conceptual model for understanding post-release opioid-related overdose risk. Addict Sci Clin Pract. 2019 Apr 15;14(1):17.
- Sung HE, Mahoney AM, Mellow J. Substance abuse treatment gap among adult parolees: prevalence, correlates, and barriers. Crim Justice Rev. 2011;36(1):40-57
- Tatara E, Ozik J, Pollack HA, et al. Agent-Based Model of Combined Community- and Jail-Based Take-Home Naloxone Distribution. JAMA Netw Open. 2024;7(12):e2448732.