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Individuals who received medication for opioid use disorder (MOUD) while incarcerated were significantly more likely to continue treatment six months after release than those who did not receive the medication, according to a new study led by the University of Massachusetts Amherst and the University of Massachusetts Chan Medical School.   

The research, published in The New England Journal of Medicine and funded by the National Institutes of Health (NIH), also found that receiving opioid use treatment in jail was associated with a 52% lower risk of fatal overdose, a 24% lower risk of non-fatal overdose, a 56% lower risk of death from any cause and a 12% lower risk of reincarceration after release. 

“These outcomes underscore the importance of providing MOUD treatment during incarceration,” says Elizabeth Evans, professor of community health education in the UMass Amherst School of Public Health and Health Sciences and senior author of the paper. “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.”

Dr. Peter Friedmann, lead author and addiction medicine physician at UMass Chan Medical School, says the findings offer promise to other regions of the nation. “The Massachusetts initiative represents a model for how jails can play a vital role in addressing the opioid epidemic in the community.” 

Evans and Friedmann are co-principal investigators of a $10 million grant from the NIH, which formed the Justice Community Opioid Innovation Network (JCOIN) in 2019. JCOIN is a nationwide research program that tests strategies to expand treatment, recovery and related services for individuals with opioid use disorder involved in the criminal justice system.

The opioid epidemic remains a devastating public health challenge in the U.S., contributing to more than 80,000 deaths in 2024 alone. People with opioid use disorder are overrepresented in jails compared to the general population. 

For example, in Greenfield, Mass., 57.5% of people booked in the Franklin County Jail screen positive for opioid use disorder, compared to about 4% of the U.S. adult population that was in need of treatment for opioid use disorder in 2022, according to the Centers for Disease Control and Prevention. 

The Franklin County Sheriff’s Office, which is housed in the same complex as the jail, provides a MOUD treatment program to individuals both pretrial and after sentencing. “We are able to offer treatment within only a few hours of being booked,” says Ed Hayes, assistant superintendent of the Franklin County Sheriff’s Office.  

The latest study analyzed data from 6,400 people with probable opioid use disorder who were incarcerated in seven Massachusetts county jails between September 2019 and December 2020. Of these, 42% received MOUD while in jail while 58% did not. Researchers monitored treatment engagement, overdose, reincarceration and mortality for all participants for up to six months after release. 

“Offering effective opioid treatment to people in jail is a critical step toward addressing the opioid crisis, promoting recovery, saving lives and reducing reincarceration,” says Dr. Nora Volkow, director of the NIH’s National Institute on Drug Abuse (NIDA). “It’s a win-win for public health.”

Despite the medication’s effectiveness, MOUD is available in only about 13% of U.S. jails and is often restricted to specific groups, such as pregnant women. This limited access contributes to forced withdrawal, increasing the risk of relapse and overdose post-release, the researchers note.

Massachusetts has been especially affected by the overdose epidemic, with fatal opioid-related overdoses quadrupling over the past two decades. In response, a 2018 state law mandated a four-year pilot program to provide all FDA-approved MOUD—buprenorphine, methadone and naltrexone—in five county jails, with two additional jails voluntarily joining the program. The law requires that individuals already receiving treatment for opioid use disorder continue it during detention, begin treatment before release when appropriate and be connected to community care after release. 

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To evaluate the impact of the pilot program, the state’s Department of Public Health partnered with the Massachusetts Justice Community Opioid Innovation Network (MassJCOIN) and participating jails to conduct a comprehensive study tracking post-release outcomes. Researchers collected data directly from incarcerated individuals and from jail administrative and clinical records. The 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. 

Treatment in jail was strongly associated with better outcomes after release. Within the first 30 days, 60.2% of those who received MOUD in jail initiated treatment in the community, compared to only 17.6% of individuals who weren’t treated. Half of the group treated in jail stayed on medication for at least 75% of the first 90 days after release, while only 12.3% of the untreated group did the same. Six months after release, 57.5% of those who received treatment in jail continued receiving MOUD, compared to just 22.8% of those who did not.

“Future research should explore whether findings can be generalized to other correctional systems, as well as how outcomes differ across population subgroups and by the type of medication received,” Evans says. “We also need to examine which strategies for implementing treatment in jails are most effective in supporting recovery after release.”