Medications for Opioid Use Disorder in Jails and Prisons: Moving Toward Universal Access

More than two million Americans are incarcerated on any given day. A large proportion of incarcerated people have an opioid use disorder (OUD), and many undergo forced withdrawal in jail or prison, increasing their risk of fatally overdosing after release. Medications for opioid use disorder (MOUDs) are a critical tool for reducing overdose risk. There are three MOUDs approved by the US Food and Drug Administration – methadone, buprenorphine, and naltrexone. Encouragingly, a growing number of correctional facilities are offering MOUDs to incarcerated people with OUD, and early results point to major health benefits. However, there remain logistical and ideological barriers to making MOUD access universal.

In April 2021, a team at the Johns Hopkins Bloomberg School of Public Health convened a group of experts to identify best practices around five critical challenges related to MOUD in jails and prisons:

• Methadone and buprenorphine regulation: How can complex controlled substance regulations be navigated in jails and prisons to make it easier to establish and maintain MOUD programs?
• Low-threshold treatment: How can treatment be provided more universally to people who could benefit without preconditions or required counseling?
• Collaboration between security and medical staff: What is the best way to achieve strong and respectful collaboration between correctional officers and medical staff?
• Harm reduction: How can MOUD programs also advance the health needs of people who use drugs and may not be ready to commit to abstinence through services such as naloxone distribution and referral to community syringe services programs?
• Reentry service and Medicaid enrollment: How can MOUD programs ensure strong transition to community services and access to Medicaid benefits upon release?

This report summarizes the major lessons learned from the convening and offers practical suggestions for making further progress on the path toward universal access.

Read and download the report.