The man swayed and stumbled between two bunk beds in a Los Angeles County jail dorm, then collapsed onto another inmate who had fallen to the floor.
The men were showing signs of having overdosed on an opioid — probably fentanyl, a powerful synthetic drug. Until recently, critical time would have been lost waiting for jail staff to come to their aid.
But security cameras captured other inmates gathering around the men, then one inmate hustling down a flight of stairs. He grabbed two small canisters that were mounted on the wall next to a pay phone and rushed back up.
In his hands were doses of naloxone, a drug that can quickly reverse the effects of opioids. He and another inmate administered the nasal spray to the two men who had overdosed — a move sheriff's officials credit with saving their lives.
The drugs were accessible as part of a pilot program the Los Angeles County Sheriff's Department launched last month. Officials last week announced plans to expand it and put the drug in dorms across L.A. County’s sprawling network of jails.
The straightforward but unusual strategy comes amid a rise in overdoses in the nation’s largest jail system, where officials continue to struggle to stop the illicit flow of fentanyl into lockups.
Dr. Sean Henderson, a physician with the county’s Correctional Health Services, said the time that is saved by giving inmates quick access to the drug can be the difference between life and death.
“We have an antidote; we know exactly what to do," Henderson said. "Why not bring the antidote as close as possible?"
Officials say the county is one of the first in the country to put naloxone in jails. The idea was born out of crisis, when a man died of a fentanyl overdose in March at the North County Correctional Facility.
After the death, sheriff’s officials reviewed security camera video, which showed the man hiding between bunks and appearing to snort a substance into his nose, said Assistant Sheriff Brendan Corbett, who oversees jail operations. When deputies walked by to check on the dorm, which they do every 30 minutes, the man, who was identified as Kevin Jovel, waved and seemed fine.
Jovel, 28, then took more drugs and soon appeared intoxicated, Corbett said. Other inmates helped him to his bed, and when deputies checked on him again, he seemed to be asleep.
Later, when inmates were unable to awaken Jovel, they clothed him and spun his mattress around to make it look as though he’d moved. Deputies assumed he had — there was no vomit, and nothing looked out of place, Corbett said.
Coroner’s officials determined Jovel was killed by the effects of fentanyl.
In a meeting after the fatal overdose, Henderson proposed putting the naloxone nasal spray in the dorms.
“We all looked at each other like, ‘Why not?’” Corbett said. “It’s the responsible thing to do.”
They weighed potential downsides: If inmates took the medication from the dispensary boxes when it wasn't needed, the jail would simply replenish the supply. The medication can’t be used to get high and actually triggers an unpleasant withdrawal reaction when used on someone who has overdosed.
“If they take it without using it, I don’t care. Then they’ll have a stash, and that’s fine too," Henderson said.
The need to try something new was clear. Sheriff Alex Villanueva signed off on the plan to give inmates access to the drug, dispensed under the brand name Narcan.
“Fentanyl is getting in,” Corbett said. “We’ve deployed Narcan four to five times this last week alone.… We’re just trying to get ahead of it,” he said.
Narcotics, Corbett said, are coming into the lockup largely through the mail. He said synthetic marijuana, known as spice, is being laced with fentanyl, then dried onto paper. Inmates tear up little pieces and drop them into their tea or tobacco.
Since 2018, sheriff's deputies and custody assistants working in jails have carried on their work belts two doses of naloxone. So far this year, the drug has been used 85 times in county jails, Corbett said, compared with 54 incidents in all of 2020. Officials said the increase may be due in part to better tracking of cases.
Sheriff's officials tested the idea of giving inmates access to Narcan with a few dozen doses in 16 dorms and three barracks in its Castaic jails. Inmates were shown a video on how to administer the spray and were instructed to notify deputies if they ever used it so that medical staff could respond, Corbett said.
“Our emphasis is always going to be putting them in appropriate therapy.... But we have a bit of an [opioid] crisis in the country, and our jail reflects the community,” Henderson said. “Trying to convince you not to take it doesn’t always work. While we’re working on that, we have to keep you safe.”
The idea has quickly paid off. The two men overdosed in the North County Correctional Facility on May 26; it is believed to be the only time inmates have used Narcan so far. Within days of the incident, the Sheriff's Department had placed Narcan in dozens more dorms and plans to continue to roll it out in other facilities. The Office of Diversion and Reentry, which provided the Narcan, said it has enough doses to supply the program for the next year.
“The fact that they’ve already saved two people’s lives is pretty remarkable,” said Kevin Fiscella, a physician who teaches at University of Rochester Medical Center and has studied opioid overdose deaths in jails. He also serves as a board member of the National Commission on Correctional Healthcare.
According to the federal Bureau of Justice Statistics, deaths in local jails across the U.S. due to drug or alcohol intoxication soared to 178 in 2018 from 37 in 2000, a rise Fiscella suspects is driven by the national opioid epidemic. In L.A. County jails alone, 10 people have died of overdoses since June 2019, sheriff's officials said.
People who use drugs face a greater overdose risk in jail or soon after their release, largely because their tolerance drops rapidly when they stop using, experts said.
"You get locked up on Friday, and by Monday, a dose that would have been safe to take on Friday is enough to kill you on Monday," said Peter Davidson, a professor at UC San Diego who studies drug abuse. "So you've got a whole bunch of people coming out who aren't necessarily super aware of that and who resume opioid use very quickly."
That's why L.A. County last year began offering Narcan to people leaving jail and has since distributed more than 34,000 doses through free vending machines set up at exits. A 2017 survey of people entering county jails found that 7% reported witnessing an overdose in the previous year, and 39% indicated that they were interested in overdose prevention and response training, according to the diversion office.
"It's so simple as just making a tool available that can change a life-or-death situation," said Shoshanna Scholar, the diversion office's director of harm reduction and community-based diversion.
This story originally appeared in Los Angeles Times.