Characteristics of Evidence-Based Treatment for Opioid Use Disorder Among County Jails

Background: Previous research has identified an underutilization of evidence-based treatment within jails to treat opioid use disorder (OUD) which may increase the potential for high-risk drug use and fatal relapse post-release. This study asks: 1) What is the range of OUD services amongst county jails in one Midwestern state?; and 2) what are the characteristics of jails that provide medication for opioid use disorder (MOUD) compared to those who do not?

Methods: Statewide data on in-jail OUD programming was collected using a survey administered by a state health department in collaboration with the same state’s Sheriff’s Association. The survey collected data from 77 county jails and three county holding facilities (80 unique counties), assessing OUD and opioid withdrawal screening instruments used along with in-jail OUD services, forms of MOUD, and continuity of care services offered. Univariate and Fisher-Freeman-Halton Exact tests with Bonferroni adjustments were conducted.

Results: Of all county jails, 14% reported using a standardized OUD screen and 43% reported using a standardized opioid withdrawal tool. The most common OUD services were counseling 44%, peer support services 30%, and 12-step programs 26%. In terms of continuity of care, 34% stated they assist with Medicaid reactivation or enrollment; 25% reported offering care transition services; and 14% stated that they distribute naloxone upon jail release. Most reported offering no forms of MOUD (50%, n=40), 28% reported offering 3 forms of MOUD, 15% (n=12) reported offering one form, and 7% (n=6) reported offering two forms. The most reported MOUD used by counties was naltrexone (40%), buprenorphine (38%), and methadone (35%). Among counties offering methadone, 29% reported that they only offer methadone to females who are pregnant. Metropolitan (75%) and urban (63%) sites were significantly more likely to report offering all three forms of MOUD as compared to rural sites (15%; Fisher-Freeman-Halton Exact= 20.528, p < .001). Sites with 3 forms (36%) of MOUD were significantly more likely to report using a standardized OUD screen than sites without MOUD (2%, Fisher-Freeman-Halton Exact =12.887, p < .01). Sites with 3 forms of MOUD were significantly more likely to state they offer counseling (91%) and peer services (68%) than those without MOUD (counseling: 13%; Fisher-Freeman-Halton Exact = 40.092, p < .001; peer services: 8%, n=3; Fisher-Freeman-Halton Exact =25.250, p < .001). Sites with 2 or 3 forms (32%) of MOUD were significantly more likely to report distributing naloxone during jail release than those without MOUD (0%; Fisher-Freeman-Halton Exact=21.206, p < .001).

Conclusions and Implications: This is the first study to describe statewide county jail OUD services. Our results suggest that county jails in this state offer a range of evidence-based treatments for OUD, including MOUD, peer supports, and continuity of care following release. It is recommended that these county jails continue to build on their progress and aim to provide all three forms of MOUD in each site, as this is considered the gold-standard of care for individuals with OUD. Future research should explore the implementation outcomes of MOUD in jail settings to inform best practices.