Evaluating the Medication for Opioid Use Disorder Treatment Outcomes of Individuals with Opioid Use Disorder in Jails

Background/Purpose: Opioid use disorder (OUD) is prevalent among carceral populations, and drug overdose is the leading cause of death for individuals re-entering the community from incarceration (Binswanger et al., 2013). Most jails in the U.S. do not offer medication for opioid use disorder (MOUD), the gold standard for OUD treatment, and there is limited research on the effects of these treatments in jail settings. When MOUD is available, there is evidence that MOUD treatment reduces the risk of overdose by 80% in the high-risk period immediately following release (Lim et al., 2022). Other interventions are more common in jails and have demonstrated mixed effectiveness in reducing the risk of post-release overdoses, such as engagement with psychosocial/behavioral treatment and peer support services (PSS) (Malta et al., 2019). However, there remains a considerable gap in the literature regarding the effectiveness of a comprehensive jail-based OUD treatment cascade in which MOUD, psychosocial services, and PSS are provided. To date, no study has examined how each of these jail-based treatment options affects post-release OUD treatment outcomes.

Methods: This study uses data from one Midwestern, metropolitan-sized jail throughout 2021. All individuals booked (N=5,495) were screened for OUD using the Rapid Opioid Dependence Screen. Individuals who screened positive (n=333) were offered a program that provided jail-based MOUD, psychosocial services, and PSS to link them to care in the community. Using Medicaid encounter data, we compare the treatment outcomes between those who screened positive for OUD and participated in the MOUD and PSS (n=70) to those who did not participate (n=263), and also compared those who received community-based PSS (n=14) to those who did not (n=56). A logistic regression model was used to predict post-jail OUD treatment engagement.

Results: The sample was predominantly male (67.6%, n=225) and white (80.2%, n=267), and averaged 35.50 years of age (range: 17-73, SD=8.9). After a 6-month period after jail release, over half received behavioral health treatment (57.2%, n=154) and just under one-quarter (23.1%, n=68) received OUD specific treatment. Individuals who participated in the OUD program were more likely to participate in post-jail behavioral health services (77.8%, n=42) than those who did not participate (52.1%, n=112; Χ2(1)=11.63, p<.001, V=.21), and more likely to receive post-jail OUD specific treatment (43.3%, n=26) than those who did not participate (17.9%, n=42; Χ2(1)=17.47, p<.001, V=.24). A logistic regression model, controlling for age, gender, and race, found that enrolled individuals were 3.2 times (95% CI=1.70-5.96, p<.001) more likely to participate in community-based OUD treatment, compared to those who did not participate.

Conclusions/Implications: Individuals who receive MOUD in jail are approximately 3-times more likely to engage in post-jail OUD treatment – potentially decreasing the likelihood of fatal overdose. Moreover, MOUD treatment was associated with behavioral health services post-release, which is important given that individuals in jail often have comorbid psychiatric concerns. This study demonstrates that MOUD in-jail treatment is vital to improving public health outcomes among a vulnerable population group, and these findings can inform criminal/legal policy that seeks to mandate this treatment modality in correctional facilities.