Development of an incarceration-specific overdose prevention video: Staying Alive on the Outside

Abstract

Objectives: The first 2 weeks following release from prison are associated with extraordinary risk of fatal drug overdose. However, bystanders can reverse opioid overdoses using rescue breathing and naloxone, an overdose antidote. We reviewed overdose prevention and naloxone administration training videos for incarceration-specific and behaviour change theory–specific content and then developed a video that addressed these gaps. Design: Systematic review of educational videos and community-based participatory video development process. Setting: Community-based organisations, correctional health programmes. Method: Video development proceeded as a community-informed, iterative process of creating and testing the acceptability of a new DVD among end-user populations, community and correctional staff. Data collection and video development advisory process included three focus groups with opioid users and formerly incarcerated individuals, two consultations with national expert groups and overdose prevention programme staff and ongoing informal presentations to correctional staff and leadership. Results: Of nine eligible and reviewed videos, three contained theory-based learning components, and only one also contained peer-based content; none directly addressed post-incarceration overdose prevention. The created 19-minute film, Staying Alive on the Outside, uses interviews, conversation and model training sessions by peers, who candidly discuss the challenges of re-entry from prison, opioid addiction and relapse and misconceptions about opioid tolerance and overdose. Viewers learn strategies to avoid overdose while using opioids and what to do in an overdose. Peer ‘learners’ and peer ‘trainers’ model the dissemination of education and naloxone administration. Conclusion: The DVD is currently used in several prisons and jails; a multi-site evaluation of programme effectiveness is discussed.