A groundbreaking study funded by the National Institutes of Health (NIH) reveals that individuals who received medication for opioid use disorder (MOUD) while incarcerated are substantially more likely to continue treatment post-release. The research, published in The New England Journal of Medicine, shows a 52% reduction in the risk of fatal opioid overdose and a 56% lower risk of death from any cause for those treated in jail. Furthermore, the likelihood of reincarceration dropped by 12% among this group.
The study analyzed data from 6,400 inmates with probable opioid use disorder across seven Massachusetts county jails from September 2019 to December 2020. Among these individuals, 42% received MOUD during their incarceration. Researchers tracked their treatment engagement, overdose incidents, reincarceration, and mortality for up to six months post-release.
Impact of MOUD in Correctional Settings
The findings underscore the critical role of providing MOUD in jails, as emphasized by Dr. Nora D. Volkow, Director of the National Institute on Drug Abuse (NIDA). “Offering effective opioid treatment to people in jail is a critical step toward addressing the opioid crisis, promoting recovery, saving lives, and reducing reincarceration,” she stated. “It’s a win-win for public health.”
The opioid epidemic continues to be a severe public health challenge in the United States, contributing to over 80,000 deaths in 2024 alone. Individuals with opioid use disorder are disproportionately represented in jails compared to the general population. Despite the proven effectiveness of MOUD, it is available in only about 13% of U.S. jails, often limited to specific groups like pregnant women, leading to increased risks of relapse and overdose upon release.
Massachusetts’ Response to the Opioid Crisis
Massachusetts, heavily impacted by the overdose epidemic, has seen fatal opioid-related overdoses quadruple over the past two decades. In response, a 2018 state law initiated a pilot program to provide all FDA-approved MOUD in five county jails, with two additional jails joining voluntarily. The program mandates continued treatment for those already receiving MOUD and facilitates treatment initiation before release, ensuring a connection to community care afterward.
The Massachusetts Department of Public Health, in collaboration with the Massachusetts Justice Community Opioid Innovation Network (MassJCOIN), conducted a comprehensive study to assess the program’s impact. Data were collected from incarcerated individuals and jail records, integrated with the Massachusetts Public Health Data Warehouse, which links over 35 state databases to track substance use disorders, incarceration, and mortality.
Results and Implications
The study found that 60.2% of individuals who received MOUD in jail initiated treatment in the community within the first 30 days post-release, compared to just 17.6% of those untreated. Furthermore, 57.5% of those treated in jail continued receiving MOUD six months after release, compared to only 22.8% of the untreated group. Most participants treated in jail received buprenorphine (67.9%), followed by methadone (25.7%) and naltrexone (6.5%).
Dr. Peter D. Friedmann, lead author and addiction medicine physician, highlighted the program’s success: “The Massachusetts initiative represents a model for how jails can play a vital role in addressing the opioid epidemic in the community.” Elizabeth A. Evans, PhD, added, “Establishing these types of programs in local jails is a powerful and effective strategy for engaging and retaining people in treatment and reducing overdose deaths after release.”
Future Research and Broader Implications
Future research should explore the generalizability of these findings to other correctional systems and analyze outcomes across different population subgroups and medication types. Investigating the most effective strategies for implementing MOUD in jails to support recovery post-release is also crucial.
This research is part of the Justice Community Opioid Innovation Network (JCOIN), a nationwide program funded by the NIH’s National Institute on Drug Abuse under the NIH Helping to End Addiction Long-term® (NIH HEAL Initiative®). JCOIN aims to expand effective treatment and recovery services for individuals with opioid use disorder within the criminal justice system.
The promising results from this study highlight the potential for jail-based MOUD programs to significantly impact public health by reducing overdose deaths and reincarceration rates, offering a hopeful path forward in the battle against the opioid crisis.
