A groundbreaking study published in The New England Journal of Medicine demonstrates that providing medication for opioid use disorder (MOUD) in correctional settings dramatically improves post-release outcomes and saves lives. The NIH-funded research analyzed data from 6,400 people with probable opioid use disorder incarcerated in seven Massachusetts county jails between September 2019 and December 2020, revealing that jail-based treatment reduced fatal opioid overdose risk by 52% and overall mortality by 56%.
The study found that individuals who received MOUD while incarcerated were significantly more likely to continue treatment six months after release compared to those who did not receive treatment. Additionally, receiving MOUD in jail was associated with a 24% lower risk of non-fatal opioid overdose and a 12% lower risk of reincarceration after release.
Treatment Engagement Shows Dramatic Improvement
The research revealed striking differences in treatment engagement between those who received jail-based MOUD and those who did not. Within the first 30 days after release, 60.2% of individuals who received MOUD in jail initiated community treatment, compared to only 17.6% of those who weren't treated during incarceration.
Long-term engagement patterns were equally compelling. Half of the group treated in jail maintained medication for at least 75% of the first 90 days after release, while only 12.3% of the untreated group achieved the same level of adherence. Six months post-release, 57.5% of those who received jail treatment continued receiving MOUD, compared to just 22.8% of those who did not receive treatment during incarceration.
The study found that most people treated in jail received buprenorphine (67.9%), followed by methadone (25.7%) and naltrexone (6.5%).
Massachusetts Pilot Program Serves as National Model
The research evaluated outcomes from a comprehensive Massachusetts initiative mandated by 2018 state law. The legislation required a four-year pilot program to provide all FDA-approved MOUD treatments—buprenorphine, methadone, and naltrexone—in five county jails, with two additional facilities voluntarily joining the program.
The law established specific requirements: individuals already receiving opioid use disorder treatment must continue it during detention, appropriate candidates should begin treatment before release, and all participants must be connected to community care after release.
"The Massachusetts initiative represents a model for how jails can play a vital role in addressing the opioid epidemic in the community," said Peter D. Friedmann, M.D., M.P.H., lead author and addiction medicine physician at the University of Massachusetts Chan Medical School.
Critical Gap in Treatment Access
Despite the demonstrated effectiveness of MOUD, the treatment remains severely limited in correctional settings. Currently, only about 13% of U.S. jails provide MOUD, and access is often restricted to specific groups such as pregnant women. This limited availability contributes to forced withdrawal, significantly increasing the risk of relapse and overdose following release.
The opioid epidemic continues to devastate American communities, contributing to more than 80,000 deaths in 2024 alone. People with opioid use disorder are overrepresented in jails compared to the general population, making correctional facilities critical intervention points.
Massachusetts has been particularly impacted by the overdose crisis, with fatal opioid-related overdoses quadrupling over the past two decades, prompting the state's comprehensive legislative response.
Comprehensive Data Integration Enables Robust Analysis
To evaluate the pilot program's impact, the Massachusetts Department of Public Health partnered with the Massachusetts Justice Community Opioid Innovation Network (MassJCOIN) and participating jails. Researchers collected data directly from incarcerated individuals and extracted information from jail administrative and clinical records.
These data were integrated with the Massachusetts Public Health Data Warehouse, which links over 35 state databases to track treatment for substance use disorders, incarceration, mortality, and other public health indicators. This comprehensive data linkage enabled researchers to conduct a robust analysis of the program's impact on key post-release outcomes.
Public Health Impact and Future Directions
"These findings demonstrate the importance of providing medications to treat opioid use disorder in correctional settings," said Nora D. Volkow, M.D., Director of 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. It's a win-win for public health."
Senior author Elizabeth A. Evans, PhD, a public health professor from University of Massachusetts-Amherst, emphasized the broader implications: "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 priorities include exploring the generalizability of these findings to other correctional systems and examining how outcomes differ across population subgroups and by medication type. Additional studies are needed to identify the most effective strategies for implementing MOUD programs in jails to support long-term recovery after release.
The research was supported by the Justice Community Opioid Innovation Network (JCOIN), a nationwide program funded by NIH's National Institute on Drug Abuse as part of the NIH Helping to End Addiction Long-term Initiative.
