top of page

Providing Medications for Opioid Use Disorder in Correctional Settings is Necessary: Effectiveness and the Best Implementation Practices  

Write-up by IRIS team member: Yali Deng

Correctional facilities in the United States (U.S.), including prisons and jails, are unique and important settings to provide evidence-based treatment for opioid use disorder (OUD), including medications for opioid use disorder (MOUD). Data from the 2007-2009 National Inmate Surveys indicate that 58% of state prisoners and 63% of sentenced jail inmates met the criteria for drug dependence or abuse (Bronson et al., 2017). In addition, 21% of individuals who died of overdose had been in county jails within two years of their death (Victor et al., 2022).

​

Providing MOUD in correctional settings, including buprenorphine, methadone, and naltrexone, has been associated with reduced overdose deaths, increased community-based treatment, and reduced recidivism (Evans et al., 2022; Strange et al., 2022). However, according to a national survey of local jails, fewer than half (43%) of the jails offered MOUD to at least some individuals, and only 13% offered MOUD to anyone with an OUD (Flanagan Balawajder et al., 2024). NIH has recently published a news release highlighting the need to close this gap in treatment access at correctional facilities. IRIS recognizes this need as well, and here seeks to amplify evidence about providing MOUD in correctional settings, to inform effective practice and policy.

​

In this research corner, we summarize two articles that, respectively, discussed the effectiveness of MOUD and the best implementation practices for correctional settings. The first article is a systematic review of the evidence on use of MOUD in correctional settings and its post-release outcomes. The second article identified ten evidence-based best practices for OUD in jails and described its availability in 185 jails across the U.S.  

Article 1

"Medications for Opioid Use Disorder During Incarceration and Post-release Outcomes"

Cates, L., & Brown, A. R. (2023). Medications for opioid use disorder during incarceration and post-release outcomes. Health & Justice, 11(1), 4. https://doi.org/10.1186/s40352-023-00209-w

In this article, the author conducted a systematic review to examine how the use of MOUDs (buprenorphine, methadone, and/or naltrexone) in prisons or jails was associated with post-release outcomes in the U.S. A total of 29 peer-reviewed empirical articles (from 22 studies) were included. Nearly all studies took place in the Northeastern and Mid-Atlantic regions. Most studies examined participants who had been in jails only (n=13), looked at methadone only (n=9), and adopted a randomization design with a treatment group and control/comparison group (n=11).

​

This review provides strong evidence of the benefits of using MOUDs during incarceration. Nearly all included studies indicate that providing MOUD in correctional facilities increases engagement in community-based treatment after release. This includes initiating MOUD or allowing people to continue their MOUD treatment. Offering MOUDs to those who are already receiving MOUDs before arrest is especially important. Failure to provide MOUD and forced withdrawal increases risk of post-release opioid-related death. Use of MOUD while incarcerated, especially methadone, was associated with a reduction in opioid use, injection drug use, and overdoses after release. More research on adoption of buprenorphine in correctional facilities is needed, considering that buprenorphine is generally more accessible in community settings. Finally, studies that examined post-release criminal involvement are also favorable, with either association between initiation of MOUD during incarceration and reduced criminal involvement (e.g., lower rates of re-incarceration and lower number of arrests) or no effect.

​

Despite compelling evidence of the effectiveness of MOUD in correctional settings, there are some barriers to implementation, such as limited implementation capacity and stigma (Grella et al., 2020). Also, the attrition from community treatment is often high after a long period post-release. In the next article, we will introduce some OUD best practices and implementation needs in jails. 

Article 2

"Availability of Best Practices for Opioid Use Disorder in Jails and Related Training and Resource Needs: Findings From a National Interview Study of Jails in Heavily Impacted Counties in the U.S."

Scott, C. K., Grella, C. E., Dennis, M. L., Carnevale, J., & LaVallee, R. (2022). Availability of best practices for opioid use disorder in jails and related training and resource needs: Findings from a national interview study of jails in heavily impacted counties in the U.S. Health & Justice, 10(1), 36. https://doi.org/10.1186/s40352-022-00197-3

This second article identified ten OUD best practices based on current practice guidelines and further examined the availability of these best practices in 185 jails selected from counties heavily impacted by opioid overdose.

​

These best practices include 1) screening for OUD, 2) clinical assessment by qualified treatment provider, 3) medically managed withdrawal, 4) MOUD administration, 5) MOUD for pregnant women, 6) counseling and wrap-around services as part of MOUD, 7) collaborative relations with community MOUD providers, 8) assistance with applications for state Medicaid/insurance coverage for MOUD, 9) re-entry services, and 10) overdose prevention. Within each category, there are several items indicating the level of services provided. On average, over 70% of the jails provided some aspects of each of the ten best practices. However, some are not fully implemented. For example, although 92% of jails have MOUD available, only 20% made MOUD available to anyone with OUD. Other areas that are less available but important for continuity of care are collaborations with community MOUD providers (61% of jails provide some form of this service), assistance with insurance applications (58%), and re-entry services (38%), such as providing written prescriptions, a bridge supply of MOUD, transportation, and connecting to a peer recovery coach.

​

This study indicates that implementing MOUD in correctional facilities needs more funding and educational support to maximize the benefits. Increased funding is needed for the medications, hiring and training clinical staff, and transportation services. In addition, over two-thirds of jails reported a need for anti-stigma education to implement MOUD, for politicians, correctional and probation staff, healthcare staff, and people who are incarcerated. Finally, more re-entry service support is needed, especially improving access to Medicaid coverage for MOUD and building collaborations with community partners. 

Conclusion

In conclusion, providing access to MOUD in correctional facilities offers societal benefits, including increasing community-based treatment engagement, reducing opioid overdose, and reducing criminal involvement. This research corner provided a glimpse of the evidence around MOUD in correctional settings. Readers who are interested in this topic can learn more through the additional resources and references below, including an implementation toolkit by SAMHSA and two related IRIS-funded studies. In addition, the Bureau of Justice Assistance started a nine-month planning initiative (starting December 2024) to increase access to medication-assisted treatment in both correctional settings and community-based settings post-release. Readers can explore their website for updated information.

References

Bronson, J., Stroop, J., Zimmer, S., & Berzofsky, M. (2017). Drug use, dependence, and abuse among state prisoners and jail inmates, 2007–2009. Washington, DC: United States Department of Justice, Office of Juvenile Justice and Delinquency Prevention. https://bjs.ojp.gov/content/pub/pdf/dudaspji0709.pdf

​

Evans, E. A., Wilson, D., & Friedmann, P. D. (2022). Recidivism and mortality after in-jail buprenorphine treatment for opioid use disorder. Drug and Alcohol Dependence, 231, 109254. https://doi.org/10.1016/j.drugalcdep.2021.109254

​

Flanagan Balawajder, E., Ducharme, L., Taylor, B. G., Lamuda, P. A., Kolak, M., Friedmann, P. D., Pollack, H. A., & Schneider, J. A. (2024). Factors Associated With the Availability of Medications for Opioid Use Disorder in US Jails. JAMA Network Open, 7(9), e2434704. https://doi.org/10.1001/jamanetworkopen.2024.34704

​

Grella, C. E., Ostile, E., Scott, C. K., Dennis, M., & Carnavale, J. (2020). A Scoping Review of Barriers and Facilitators to Implementation of Medications for Treatment of Opioid Use Disorder within the Criminal Justice System. International Journal of Drug Policy, 81, 102768. https://doi.org/10.1016/j.drugpo.2020.102768

​

Strange, C. C., Manchak, S. M., Hyatt, J. M., Petrich, D. M., Desai, A., & Haberman, C. P. (2022). Opioid‐specific medication‐assisted therapy and its impact on criminal justice and overdose outcomes. Campbell Systematic Reviews, 18(1), e1215. https://doi.org/10.1002/cl2.1215

​

Victor, G., Zettner, C., Huynh, P., Ray, B., & Sightes, E. (2022). Jail and overdose: Assessing the community impact of incarceration on overdose. Addiction, 117(2), 433-441. https://doi.org/10.1111/add.15640 ​

bottom of page