Bridging institutional logics: Implementing naloxone distribution for people exiting jail in three California counties. (September 2021)

• Record Type: Journal Article
• Authors: Showalter, David; Wenger, Lynn D.; Lambdin, Barrot H.; Wheeler, Eliza; Binswanger, Ingrid; Kral, Alex H.
• Is Part Of: Social science & medicine. Volume 285(2021)
• Publication Date: 2021-09
• Subjects: Opioid overdose -- Overdose -- Harm reduction -- Incarceration -- Institutional logics -- Interorganizational bridge -- Champion -- Implementation science; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2021.114293
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Drug overdose is the leading cause of death among formerly incarcerated people. Distribution of the opioid overdose medication naloxone to people who use drugs reduces overdose mortality, and officials in many jurisdictions are now considering or implementing programs to offer naloxone to people exiting jails and prisons. The principles and practices of harm reduction programs such as naloxone distribution conflict with those of penal institutions, raising the question of how organizations based on opposing institutional logics can collaborate on lifesaving programs. Using in-depth interviews and observations conducted over four years with 34 penal, medical, public health, and harm reduction practitioners, we introduce and conceptualize two organizational features to explain why this therapeutic intervention was implemented in local jails in two of three California counties. First, interorganizational bridges between harm reduction, medical, and penal organizations facilitated mutual understanding and ongoing collaboration among administrators and frontline workers in different agencies. Second, respected and influential champions within public health and penal organizations put jail-based naloxone distribution on the local agenda and cultivated support among key officials. Our findings offer guidance for future studies of institutional logics and policy responses to the overdose crisis. Highlights: Naloxone distribution to people exiting jail is an important harm reduction program. Penal facilities and harm reduction programs use conflicting institutional logics. Conflicts between institutional logics create barriers to implementing new programs. Interorganizational bridges facilitate collaboration across institutional logics. Internal champions build support among stakeholders for implementing new programs.