NEW YORK (Reuters) - The inmates filed into a room at a New York prison, squeezed into classroom-style desks, and watched a guard demonstrate how a small plastic tube could help them save lives when they return to the streets of a nation gripped by an opioid epidemic.

The weekly class at the Queensboro Correctional Facility in New York City is part of a state program to expand access to naloxone, a drug delivered through a nasal spray that can quickly revive someone who is overdosing on heroin or an opioid-based prescription painkiller.

By giving naloxone kits to inmates upon their release, New York state officials hope those in need will have a better chance of getting the antidote in time.

Some of the prisoners, dressed in baggy green prison uniforms, were surprised by the simplicity of the naloxone kits as they recalled the painful loss of friends or relatives killed by opioid addiction.

“It makes me think, ‘Jesus, if she had that, she would be saved’,” said Marc Webb, 34, reflecting on the overdose death of a close friend a few years ago. “I wish they had a nasal spray to stop addiction, period.”

Although opioid addiction has spread to many different communities across the United States, recently released prisoners are more vulnerable to overdosing, particularly those who do not realize their tolerance has dropped while inside, studies show.

Between 2010 and 2016, the number of people killed nationwide each year by opioid overdoses doubled to more than 42,000, according to the U.S. Centers for Disease Control and Prevention. Around 40 percent of those deaths are from prescription painkillers such as Oxycontin and Percocet. In April, with the epidemic worsening, the U.S. surgeon general urged more Americans to carry naloxone, also known as Narcan.

LIVES SAVED

Kevin Small, who spent 25 years in prison for his role in a murder-robbery, took the class in 2015 after briefly going back to prison for smoking marijuana, a parole violation. Naloxone was completely new to him at the time.

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After his release, Small, 57, was hanging out one day with friends in his old New York neighborhood of Jamaica when he noticed a man he knew to be a heroin addict slumped on the sidewalk, barely conscious.

The instructions from the class came back to him. An uncomfortable knuckle rub on the man’s sternum drew no response. Small could see the man’s pupils were pinpricks. He moved the man onto his side and fished the naloxone out of his bag.

“One dose, two dose,” Small recalled. “Maybe 30 seconds went by. He started to come out of it.”

Small called an ambulance, and the paramedic praised him and replaced his kit. The guys on the block ribbed him, Small said: “‘Oh, Dr. Kevin! Oh, Dr. Small!’”

Months later, Small was smoking outside a friend’s house. A stranger staggered toward him and slumped in the street. Small grabbed his backpack and got to work once again.

INCREASING AWARENESS

The program began in early 2015 when Dennis Breslin, superintendent of the Queensboro prison, noticed an advertisement for naloxone training at his local YMCA. His first notion was to train only guards, but he soon saw that as a half measure.

The state’s Department of Health and Department of Corrections has since expanded the program to more than a dozen other jails and prisons throughout the state.

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At least 15,500 inmates or parolees have received the training in the program’s first three years, with more than 6,350 of them taking home naloxone kits, at a cost of about $555,000 so far. Similar programs have started at jails in Chicago and Baltimore.

In a report published in March, the Vera Institute of Justice, a nonprofit research group, called the New York program “promising,” saying it significantly increased awareness of how to deal with overdoses and that about two-thirds of inmates took the kits upon release.

“Our inmates are returning to the communities they came from,” Breslin, the prison superintendent, said. “They’re going to find people who are using, if not abusing, opioid drugs.”

Besides Small, Breslin is aware of at least 12 other times a former inmate has used the kit they took with them to revive someone.

“There’s drug addicts all around us,” Small said. “Some we know, some we don’t.”