Medications for Opioid Use Disorder in County Jails - Outcomes after Release.

Area of Science:

• Public Health
• Addiction Medicine
• Criminology

Background:

• Seven Massachusetts county correctional facilities piloted Food and Drug Administration-approved medications for opioid use disorder (MOUD) in 2019.
• This initiative aimed to address opioid use disorder (OUD) within carceral settings.

Purpose of the Study:

• To examine the association between receiving MOUD in jail and postrelease outcomes.
• To compare MOUD receipt, overdose, death, and reincarceration rates among individuals with probable OUD who did or did not receive MOUD in jail.

Main Methods:

• Observational study utilizing linked state data from September 1, 2019, to December 31, 2020.
• Included 6400 individuals with probable OUD; 2711 received MOUD in jail, 3689 did not.
• Log-binomial and proportional-hazards models were adjusted for propensity-score weights and baseline covariates.

Main Results:

• MOUD receipt in jail was associated with a 52% lower risk of fatal overdose (aHR, 0.48) and a 24% lower risk of reincarceration (aHR, 0.88).
• Treated individuals showed decreased risks for nonfatal overdose (aHR, 0.76), death from any cause (aHR, 0.44), and increased likelihood of postrelease MOUD initiation (aRR, 1.44).
• Buprenorphine was the most common MOUD in jail (67.9%), followed by methadone (25.7%) and naltrexone (6.5%).

Conclusions:

• Receipt of MOUD in jail significantly decreased postrelease risks of overdose, all-cause mortality, and reincarceration.
• Jail-initiated MOUD improved continuity of care, increasing the likelihood of postrelease MOUD initiation.
• Findings support the expansion of MOUD programs within correctional facilities to improve public health outcomes.