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Supporting the Wellness and Recovery of People Receiving Medication Treatment at Baltimore County Detention Center: A Qualitative Study

Project Lead: Dr. Brook Kearley


The rise of fatal drug overdoses remains a significant public health crisis in the United States, with a drastic increase of over 40% lives lost since 2019¹. These national statistics parallel the rates of Maryland opioid-related deaths. Returning citizens are at a much higher risk of opioid-related deaths than the general population²⁻⁴. In the first two weeks of community reentry, opioid overdoses are estimated to be 40 times greater than the general population⁵. FDA-approved medications such as methadone, buprenorphine, and naltrexone are effective in reducing opioid overdoses and have been shown to reduce both opioid use and mortality among correctional populations² ⁶. Despite the proven benefits, medications for opioid use disorder (MOUD) is not offered in many prisons and jails. To address this critical service gap, Maryland passed House Bill 116 (effective January 2023) which requires local detention facilities to offer MOUD to incarcerated individuals with opioid use disorder (OUD). The Baltimore County Detention Center (BCDC) provides MOUD to incarcerated individuals and links them to case managers, outpatient psychosocial services, peer recovery specialists, and community MOUD providers. The purpose of this study is to inform and improve BCDC and other jail-based services by collecting the perspectives of BCDC staff and MOUD program consumers regarding the strengths and challenges of the BCDC MOUD program.     



Data for this study come from two primary sources: interviews with five Baltimore County Department of Health staff members who work with consumers receiving MOUD at BCDC; and 12-month follow-up interviews with 55 BCDC MOUD consumers that included a combination of open-ended questions and standardized survey items from the Center for Substance Abuse Treatment (CSAT), Government Performance Results and Modernization Act (GPRA) tool⁷. Qualitative data (staff and consumer interview responses) were analyzed using Rapid Analysis Coding. Quantitative data were analyzed using SPSS v 27 and included univariate analyses to examine the distribution for categorical variables and the central tendency and dispersion for continuous variables.  


Consumers interviewed stated that the BCDC MOUD program prevented opioid relapse following release from jail. Not only were the medications themselves important to prevent withdrawal and reduce cravings; the program also connected consumers to ancillary programs and MOUDs upon release. The social support and behavioral therapy provided by peer support and clinical staff in the jail and community were key factors in motivating consumers and fostering recovery.  Consumers and staff also had valuable suggestions, to include: 1.) ensuring that MOUDs are offered at jail intake to all people who screen positive for OUD; 2.) providing more therapy and opportunities for learning and recovery support; 3.) providing MOUDs at a consistent daily time; 4.) addressing consumer safety in regards to other incarcerated people pressuring consumers to share medication; 5.) addressing MOUD stigma among staff and consumers; 6.) enhancing reentry services; and 7.) increasing collaboration within and between departments and agencies that serve this population.  


We provide the following recommendations: conduct an inventory of current individual and group therapy options and consider ways to increase therapy offerings, to include the unique needs of polysubstance users; ensure prompt access to medication in the desired formulary for both those receiving community-based MOUD at entry as well as for those who screen positive for OUD; ensure MOUDs are provided at a consistent daily time to reduce the potential for cravings and withdrawal; ensure MOUD program participant safety via a diversion risk protocol and/or consider housing MOUD participants in a single unit; map out current reentry planning process and determine areas for improvement to ensure warm hand offs and robust community supports; and hold regular cross-departmental and agency meetings – via an implementation team structure – to ensure communication and collaboration; and identify a peer-led MOUD stigma training for all jail staff and MOUD program participants in order to improve program acceptance and performance.  


¹National Institute on Drug Abuse (NIDA). (2023, Feb 9). Trends & Statistics: Drug Overdose Death Rates.     


²Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D. J., Gibson, A., Mattick, R., Butler, T., & Burns, L. (2014). The impact of opioid substitution therapy on mortality post-release from prison: Retrospective data linkage study. Addiction, 109(8), 1306–1317.    


³Maryland Opioid Operational Command Center. (2021). 2020 Annual Report. Retrieved June 5, 2021, from  


⁴Zlodre, J. & Fazel, S. (2012). All-cause and external mortality in released prisoners: Systematic review and meta-analysis. American Journal of Public Health, 102(12).   


⁵Ranapurwala, S. I., Shanahan, M. E., Alexandridis, A. A., Proescholdbell, S. K., Naumann, R.B., Edwards Jr, D., & Marshall, S. W. (2018). Opioid overdose mortality among former North Carolina inmates: 2000–2015. American Journal of Public Health, 108(9), 1207-1213.   


⁶Dolan, K. A., Shearer, J., White, B., Zhou, J., Kaldor, J., & Wodak, A. D. (2005). Four-year follow-up of imprisoned male heroin users and methadone treatment: Mortality, reincarceration and hepatitis C infection. Addiction, 100(6), 820– 828.   


⁷Substance Abuse and Mental Health Services Administration (2023, October 3). CSAT GPRA Modernization Act data collection tools. 

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