Provision of Medications for Opioid Use Disorder in Jails Associated with Reductions in Mortality and Re-incarceration

Among persons with opioid use disorder (OUD), release from incarceration is strongly associated with overdose death and all-cause mortality, but few jails offer medication for OUD (MOUD). In 2019, Massachusetts began a pilot MOUD program in seven of 13 jails statewide. This study used extensive state administrative data to evaluate the association between provision of MOUD while incarcerated and post-release MOUD continuity, opioid-related overdose, mortality, and re-incarceration.

• Among a cohort of 6400 persons with probable OUD, 42 percent received MOUD in jail (68 percent buprenorphine, 26 percent methadone, 7 percent naltrexone). Continuation of community MOUD made up 74 percent of those receiving MOUD in jail.
• Compared with not receiving MOUD in jail, receipt of MOUD while incarcerated was associated with higher incidence of post-release MOUD initiation (60 percent versus 18 percent), three-month MOUD engagement (50 percent versus 12 percent), and six-month MOUD retention (58 percent versus 23 percent).
• Compared with those not receiving MOUD in jail, individuals receiving MOUD had lower risk of post-release fatal overdose (adjusted hazard ratio [aHR], 0.48), non-fatal overdose (aHR, 0.76), death from any cause (aHR, 0.44), and re-incarceration (aHR, 0.88), but not incidence of hospitalization.

Comments: This study extends to the jail setting the robust evidence of improved treatment retention and survival associated with MOUD receipt that has been observed in community treatment settings. The novel finding of reduced re-incarceration associated with MOUD receipt while incarcerated adds to the public health rationale for expanding MOUD treatment to all carceral settings. The current widespread practice of withholding MOUD in jails and prisons, even for those already engaged in treatment, is putting lives and the community at risk and should be ended.

Joseph Merrill, MD, MPH

Reference: Friedmann PD, Wilson D, Stopka TJ, et al. Medications for opioid use disorder in county jails–outcomes after release. N Engl J Med. 2025;393(10):994–1003.