| Course | PAC 799A Addiction Studies Capstone |
|---|---|
| Module | Module 6 |
| Paper type | Capstone Chapter 2 |
| Length | About 1,094 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Psychology and Addiction Studies |
| Updated | October 2026 |
Free sample paper for PAC 799A Module 6
Chapter 2: What Is Known About Overdose, Naloxone and the Moment of Release
Student Name
Psychology and Addiction Studies Program, Aspen University
PAC 799A: Addiction Studies Capstone
Instructor Name
Month Day, Year
Chapter 2: What Is Known About Overdose, Naloxone and the Moment of Release
Introduction and Search
The studies gathered here underpin Avery's look at naloxone offered to people leaving Pine Hollow, the county jail in Georgia imagined for this capstone. Following the plan set out in the previous module, Avery searched three databases with strings combining naloxone, overdose and custody terms, applied inclusion rules set in advance and included thirty-four studies after screening. The chapter is organized in four themes and ends with the gaps the project addresses.
Theme One: Overdose After Release
Binswanger et al. (2007) linked records of everyone released from Washington State prisons over several years to death records. Across the whole follow-up, former prisoners died at roughly three and a half times the rate of comparable residents, but the excess was far greater just after release, when overdose dominated the causes of death. Their study established the size of the danger in one large population. Merrall et al. (2010) asked whether the pattern held elsewhere. Pooling cohort studies from several countries, they compared drug-related deaths in the first fortnight after release with those in the following ten weeks and found a consistently higher rate in the first fortnight. Together, the two studies show that the danger is large, general across systems and concentrated in a short window, which is why the moment of release is a logical point for prevention.
Theme Two: Does Take-Home Naloxone Work?
Evidence on naloxone distribution comes almost entirely from observational studies, since withholding naloxone in a trial would be unethical. McDonald and Strang (2016) addressed this by judging the evidence against the Bradford Hill criteria. They found strong support on several: naloxone administered by bystanders was associated with survival in the large majority of recorded uses, results were consistent across settings and the timing fit a causal effect. They concluded that take-home naloxone programs reduce overdose deaths. Walley et al. (2013) added a dose-response finding, one of the Bradford Hill criteria, from Massachusetts. Comparing communities over time, they found that those with higher enrollment per head of population in overdose education and naloxone distribution had lower overdose death rates than communities without the program, with larger reductions at higher enrollment.
Theme Three: Naloxone and Medication at Release
Bird et al. (2016) evaluated Scotland's national program, which from 2011 included supplying naloxone to people leaving prison. Comparing the five years before with the three years after, they found that deaths within four weeks of release made up a smaller share of all opioid deaths after the program began. Their before-and-after design cannot exclude other changes over the same period, but the finding is the most direct evidence that naloxone at release is associated with fewer deaths soon after it. Green et al. (2018) studied a related change in Rhode Island, where the combined jail and prison system began offering all approved medications for opioid use disorder. In the following year, deaths among recently released people fell markedly. Their study is short and observational, but it shows that action inside corrections can change what happens after release. Notably, neither study reports how many people declined what was offered.
Theme Four: Defaults and Choices
The project's test of an opt-out offer rests on research outside addiction. Johnson and Goldstein (2003) found that consent to organ donation differed sharply between countries depending on whether the default was to donate or not, and an online experiment showed the same effect when only the default changed. Their explanation, that defaults cost no effort, signal a recommendation and spare people a difficult decision, applies plausibly to the release desk, where accepting a kit in front of officers may feel like an admission. No included study tested an opt-out naloxone offer in a jail.
Synthesis
| Study | Design | Setting | Main finding | Relevance to project |
|---|---|---|---|---|
| Binswanger and colleagues | Cohort | Washington State prisons | Overdose death risk extreme in first two weeks after release | Background; why release matters |
| Merrall and colleagues | Meta-analysis of cohorts | Several countries | Drug-related deaths concentrated in first two weeks | Confirms the window is general |
| McDonald and Strang | Systematic review with causal criteria | International | Take-home naloxone reduces overdose deaths | Supports naloxone as worth distributing |
| Walley and colleagues | Interrupted time series | Massachusetts communities | More enrollment, lower death rates | Reach matters; supports uptake as outcome |
| Bird and colleagues | Before and after | Scotland | Smaller share of deaths soon after release once naloxone was supplied | Most direct evidence for naloxone at release |
Gaps and How the Project Addresses Them
Two gaps follow from the review. First, published evaluations of naloxone at release describe kits distributed but not uptake as a share of those eligible, nor why people decline; RQ1 and RQ2 address this. Second, the defaults research has not been applied to naloxone at release, and no study has tested an opt-out offer in a jail; RQ3 addresses this, with RQ4 joining the strands. The review also shapes the method: since observational designs dominate, the project's interrupted time series follows the approach Walley and colleagues used, and its limits will be stated as theirs were.
Quality of the Evidence Overall
Across the four themes, the firmest evidence concerns the size and timing of overdose risk after release, which rests on large linked-record cohorts and a meta-analysis. It is moderately strong on the effectiveness of naloxone distribution, which rests on consistent observational studies judged against causal criteria. It is weakest on naloxone at release specifically, which rests on one national before-and-after comparison, and it is absent on uptake and on opt-out offers in custody.
Points of Disagreement
The studies largely agree, but they differ in ways that matter for the project. The cohort studies measure risk in prisons, where stays are longer than in jails, and loss of tolerance may be greater after a long sentence than after a short jail stay. The naloxone studies measure kits distributed or communities enrolled, not the share of eligible people reached. And the defaults evidence comes from decisions such as organ donation, made on a form, rather than from a face-to-face exchange at a release desk. Each difference is a reason the project's findings cannot be predicted from the literature and must be measured.
Summary
Overdose risk peaks in the first weeks after release; take-home naloxone reduces overdose deaths, and wider reach brings larger reductions; naloxone and medication at release are associated with fewer deaths soon after release; and defaults strongly influence choices. What is missing is evidence on uptake and refusal at release and on whether an opt-out offer raises uptake. Chapter 3 will describe the method designed to supply it.
References
Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison: A high risk of death for former inmates. New England Journal of Medicine, 356(2), 157-165. https://doi.org/10.1056/NEJMsa064115
Bird, S. M., McAuley, A., Perry, S., & Hunter, C. (2016). Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths: A before (2006-10) versus after (2011-13) comparison. Addiction, 111(5), 883-891. https://doi.org/10.1111/add.13265
Green, T. C., Clarke, J., Brinkley-Rubinstein, L., Marshall, B. D. L., Alexander-Scott, N., Boss, R., & Rich, J. D. (2018). Postincarceration fatal overdoses after implementing medications for addiction treatment in a statewide correctional system. JAMA Psychiatry, 75(4), 405-407. https://doi.org/10.1001/jamapsychiatry.2017.4614
Johnson, E. J., & Goldstein, D. (2003). Do defaults save lives? Science, 302(5649), 1338-1339. https://doi.org/10.1126/science.1091721
McDonald, R., & Strang, J. (2016). Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction, 111(7), 1177-1187. https://doi.org/10.1111/add.13326
Merrall, E. L. C., Kariminia, A., Binswanger, I. A., Hobbs, M. S., Farrell, M., Marsden, J., Hutchinson, S. J., & Bird, S. M. (2010). Meta-analysis of drug-related deaths soon after release from prison. Addiction, 105(9), 1545-1554. https://doi.org/10.1111/j.1360-0443.2010.02990.x
Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., & Ozonoff, A. (2013). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. BMJ, 346, Article f174. https://doi.org/10.1136/bmj.f174
PAC 799A Module 6 instructions, in plain terms
Chapter 2 is the sixth module of PAC 799A, and assignments usually ask for a full literature review organized by themes that lead to your project's gaps. Follow the Module 6 instructions in your Aspen course; the jail here is invented. Open with a brief description of your search. Organize by themes tied to your research questions, comparing studies within each. Appraise study designs and note their limits. Include a synthesis table. End with gaps stated specifically and connected to your questions and method. Keep the review focused; it supports the project rather than surveying everything. Cite every source in APA 7. Where a theme draws on another field, explain in a sentence or two why that evidence applies to your setting.
How this PAC 799A Module 6 example is built
Chapter 2 of the composite jail capstone summarizes the search of three databases and the thirty-four studies included. Theme one draws on Binswanger and colleagues' Washington cohort and Merrall and colleagues' meta-analysis. Theme two weighs McDonald and Strang's Bradford Hill review and Walley and colleagues' Massachusetts time series. Theme three uses Bird and colleagues' evaluation of Scotland's program and Green and colleagues' Rhode Island study. Theme four uses Johnson and Goldstein on defaults. A five-row table compares designs and findings. The gaps are uptake and refusal at release and opt-out offers of naloxone, both untested in jails. A closing paragraph shows how the dominance of observational designs in the literature shaped the project's own method.
Where the marks sit in the PAC 799A Module 6 rubric
Literature review chapters earn credit for synthesis by theme, honest appraisal of study designs and gaps that lead directly to the project. This example compares studies within each theme, for instance noting that the Scottish comparison by Bird and colleagues leaves room for other explanations. It uses McDonald and Strang's causal criteria to weigh observational evidence. The synthesis table makes designs and findings easy to compare. The fourth theme brings in evidence from outside addiction, defaults research, and explains its relevance. The gaps are stated as missing knowledge and tied to each research question. The chapter also notes what no included study reports, kits declined, which turns an absence in the literature into the project's focus.
Common PAC 799A Module 6 mistakes, and how to avoid them
Literature review chapters often summarize one study per paragraph. Let themes, not authors, carry the structure, and set studies against one another inside each. Appraise designs: a cohort, a time series and a randomized trial support different claims. Bring in relevant evidence from other fields when your framework needs it. State gaps precisely and connect them to your questions. Keep the chapter focused on what your project needs. Use your synthesis matrix to check that every theme has enough evidence and that no key study is missing. Write the gap section first in rough form; it tells you which studies each theme must include. Revisit the draft after Chapter 3 is planned, since the method often reveals a study the review should discuss, such as one using the same design.
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PAC 799A Module 6 questions, answered
What does PAC 799A Module 6 usually ask for?
Aspen's PAC 799A covers Chapter 2, the literature review, in this module, so a thematic review leading to your project's gaps is typical. Check your Module 6 prompt.
When is overdose risk highest after release?
In the first two weeks; Merrall and colleagues found drug-related deaths several times more frequent in that window than in the following weeks.
Did giving naloxone at release reduce deaths in Scotland?
Bird and colleagues found the share of opioid deaths within four weeks of prison release fell after the national program began, though their design cannot exclude other causes.
Where can I find a free PAC 799A Module 6 sample paper?
The full Chapter 2 is on this page: four themes, a synthesis table and the gaps that lead to the jail naloxone project.
Why include research from outside addiction in a literature review?
When your framework comes from another field, as defaults research comes from behavioral economics, that evidence explains why your intervention might work.