Jail-based opioid treatment implementation, outcomes, and costs: lessons learned from the Massachusetts Justice...

Limited access to medications for opioid use disorder (MOUD) is a major driver of the opioid overdose crisis. Jails have been slow to implement MOUD treatment, especially agonist medications (methadone, buprenorphine). Massachusetts mandated certain county jails pilot-test delivery of all FDA-approved MOUD treatments, stipulating jails continue MOUD, or initiate it prior to release, and facilitate MOUD continuation in the community post-release. The Massachusetts Justice Community Opioid Innovation Network (MassJCOIN) partnered with seven pilot jails, the Massachusetts Department of Public Health, and community treatment providers to conduct a Type 1 hybrid effectiveness-implementation study of this carceral MOUD program. Drawing from selected MassJCOIN evidence on MOUD treatment program implementation, outcomes, and costs, we consider how findings can inform more effective, humane public health and clinical responses to treating incarcerated individuals. MOUD treatment in jail improves treatment engagement, reduces recidivism, and saves lives. MOUD program implementation facilitators included: policies and processes to offer universal MOUD access; transformative and adaptive leadership; appropriate staffing capacity and capabilities; proactive prevention of MOUD diversion; and consideration of patient preferences for MOUD treatment and co-occurring mental health conditions. MOUD program success was influenced by the legislative mandate and other major statewide changes and a community-based treatment system conducive to MOUD implementation. MOUD treatment continuity post-release was facilitated by re-entry planning and preparing individuals for post-release risk environments. Site-specific costs of implementing and sustaining MOUD programming provide information for decisions about program design, budgetary needs, and resource allocation. Carceral MOUD programming is a compelling strategy to advance public safety and public health. Lessons learned provide a playbook for broader diffusion of carceral MOUD programs and can help carceral leadership, healthcare providers, and policymakers make carceral healthcare improvements. Within a harm reduction framework, carceral MOUD treatment can provide substantial opportunities to fill gaps in public health prevention efforts and clinical care to reduce opioid overdose and other concomitant risks. Carceral MOUD programming offers ways for carceral systems to work for the common good, garner trust in public institutions, and increase their legitimacy and value as public institutions.