Developing a cascade of care for opioid use disorder among individuals in jail

The overdose epidemic persists as a public health crisis in the United States. Jails are a critical overdose prevention touchpoint. The risk of overdose postincarceration may be increased if an individual is released without medication for opioid use disorder (MOUD) treatment or transferred to long-term residential treatment. A growing number of studies have examined the difficulties in implementing evidence-based care for opioid use disorder (OUD) in jail settings.

We use administrative data (July 1, 2020, through September 30, 2020) from four jail facilities that implemented OUD treatment programs. These data included screening data from the Rapid Opioid Dependence Screener (RODS) (n = 2562), along with booking and medication information from jail records, which we used to develop a cascade-of-care.

Screening rates varied dramatically by facility, with integration into the jail records management system showing the best outcomes. The prevalence of OUD identified from the RODS was 8.1% and did not vary significantly by facility. Nearly one third (31.3%) of those identified as having an OUD were dispensed medications, with two-thirds receiving methadone and the remaining third buprenorphine. The average length of stay for all screened individuals was two weeks, compared to two months for those who received an MOUD.

Screening for OUD diagnosis is critical to reduce gaps in a cascade-of-care, and our results provide guidance on how to achieve this in jail. Failing to identify OUD and provide MOUD places an individual at an increased risk for fatal overdose. Future studies should consider examining MOUD discharge planning and factors that improve treatment retention following release from incarceration. Our study also illustrates the churn of jail populations and the need for rapid induction of treatment and overdose prevention strategies upon release.