Key Highlights

Here are the main takeaways from our discussion on Medication for Opioid Use Disorder (MOUD):

• MOUD is the most effective, gold-standard treatment for individuals with a substance use disorder involving opioids, as highlighted in a systematic review of current evidence on its effectiveness.
• Implementing MOUD within correctional facilities significantly reduces the risk of fatal opioid overdose after release.
• Despite its effectiveness, MOUD remains widely unavailable in most jails and prisons across the country.
• Providing MOUD is a crucial public health strategy that saves lives and improves community well-being.
• Federal courts have increasingly recognized that denying MOUD can violate the rights of incarcerated individuals.

Introduction

Opioid use disorder (OUD) and the criminal legal system are tightly linked. National data suggest that roughly 65% of people in U.S. prisons meet criteria for a substance use disorder, far higher than in the general population. NIDA For many, untreated OUD is part of the pathway into jail or prison and a major driver of poor health after release.

The period immediately after release is especially dangerous. Multiple studies have found that people recently released from custody are many times more likely to die of an overdose than the general public, with risk peaking in the first days and weeks post-release.

Medication for Opioid Use Disorder (MOUD) is the evidence-based way to change that trajectory in the United States. When started or continued inside a facility and linked to care in the community, MOUD lowers overdose risk, supports long-term recovery, and improves public safety. This approach is strongly supported by agencies like the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Authoritative resources include:

• CDC – MOUD and linkage to care
• SAMHSA – Medications for Substance Use Disorders

What MOUD Is and What It Is Not

“Medication for Opioid Use Disorder” refers to three FDA-approved medications:

• Methadone – a full opioid agonist dispensed through certified opioid treatment programs.
• Buprenorphine – a partial agonist with a “ceiling effect,” lowering overdose risk.
• Naltrexone (often extended-release) – an opioid antagonist that blocks opioid effects.

These medications:

• Stabilize brain chemistry and reduce cravings
• Prevent or lessen withdrawal symptoms
• Reduce the rewarding effects of illicit opioids

They are not “substituting one drug for another.” As SAMHSA notes, they are evidence-based treatments for a chronic medical condition, similar in principle to using insulin for diabetes or inhalers for asthma.

In correctional settings, treatment of OUD with MOUD can be used to include behavioral therapy for enhanced recovery support:

• Continue treatment started in the community
• Initiate treatment for people who screen positive for OUD at intake
• Support safer transitions back to the community when release is approaching

Why Correctional Settings Are a Critical Intervention Point

High prevalence of OUD

Because of the over-representation of substance use disorders in the justice-involved population, jails and prisons hold one of the largest concentrated groups of people with untreated OUD in the country.

That reality creates both:

• A risk: people cycling through custody without treatment, then returning to communities at high overdose risk.
• An opportunity: a controlled setting where screening, diagnosis, and initiation of MOUD can actually be easier to coordinate than in fragmented community systems.

Elevated overdose risk after release

When someone stops using opioids abruptly in custody, tolerance drops. If they return to pre-incarceration doses after release, the risk of overdose skyrockets. Analyses of post-release outcomes have documented:

• Overdose death rates many times higher than in the general population
• The highest risk in the first 1–2 weeks after release.

Providing MOUD during incarceration, and ensuring a warm hand-off to community care, directly targets this lethal window.

How MOUD Compares to Traditional Approaches

Historically, many jails and prisons relied on:

• Forced withdrawal (“detox”) on intake
• Short-term symptom management without ongoing medication
• No continuity of care when people left the facility

These approaches may temporarily stop drug use inside the walls, but they increase overdose risk after release by lowering tolerance with no ongoing support.

By contrast, MOUD:

• Treats OUD as a chronic medical condition
• Provides ongoing stabilization rather than a one-time withdrawal
• Has robust evidence for reducing overdose deaths and improving retention in treatment .

For facilities seeking to align with current medical standards and federal guidance, MOUD is now considered the gold standard, not an optional add-on.

Current Access to MOUD in Jails and Prisons

Despite strong evidence, access remains limited.

Recent national work (for example, a 2024 JAMA Network Open analysis of U.S. jails) .

• Only a minority of jails offer any MOUD at all
• Fewer still offer all three medications
• Access varies widely by state, facility type, and local policy

Prisons, which house people for longer sentences, are somewhat more likely to offer at least one MOUD option. Local jails with shorter stays but very high churn often have the least comprehensive programs, even though they see large numbers of people with untreated OUD.

This patchwork means a person’s access to a life-saving, evidence-based treatment can depend almost entirely on where they are arrested or incarcerated.

Barriers to MOUD Implementation

1. Stigma and misconceptions

Common misconceptions include:

• “MOUD just replaces one drug with another.”
• “People should get clean without medications.”

These views conflict with decades of research showing that methadone, buprenorphine, and naltrexone improve survival and reduce illicit opioid use. Education for custody staff, medical teams, and local policymakers is essential to shifting practice.

2. Security and diversion concerns

Facility leaders often worry about:

• Diversion of medications
• Misuse or trafficking inside the facility

However, systems that have implemented MOUD at scale have shown that with supervised dosing, secure storage, and clear protocols, diversion can be managed much like any other controlled medication in a correctional pharmacy.

3. Staffing, training, and funding

Practical barriers include:

• Limited on-site medical staff or prescribers
• Lack of training in addiction medicine
• Tight budgets and competing priorities

Toolkits from SAMHSA and allied partners provide step-by-step guidance on developing protocols, training staff, and partnering with community opioid treatment programs. See, for example, SAMHSA’s criminal-justice MAT brief: and its 2025 prison MOUD implementation guidelines.

Legal and Policy Landscape: Why MOUD Is Increasingly Required

Eighth Amendment and serious medical needs

U.S. courts have long held that deliberate indifference to serious medical needs can violate the Eighth Amendment. As more courts recognize OUD as a serious medical condition with an established standard of care, blanket bans on MOUD are increasingly vulnerable to legal challenge. DRNC

Americans with Disabilities Act (ADA)

The U.S. Department of Justice has clarified that opioid use disorder (OUD treatment), when it substantially limits one or more major life activities, is a disability protected under the ADA. Denying access to MOUD solely because a person is incarcerated or has a history of addiction during the opioid epidemic can constitute discrimination.

Further guidance is available at:

• ADA.gov – civil rights protections and OUD:

Federal guidance and funding signals

Several federal agencies emphasize MOUD as a key element of overdose prevention and community safety:

• CDC – highlights MOUD as a central strategy in overdose prevention and linkage to care.
• SAMHSA – provides specific guidance for the criminal justice system and promotes access to all three medications.
• Bureau of Justice Assistance (BJA) – through its Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP), funds jurisdictions that expand MOUD in justice settings.

Taken together, these signals are pushing jails and prisons toward a new norm: treating OUD with MOUD as part of constitutionally adequate, evidence-based medical care.

Outcomes When Facilities Provide MOUD

Overdose deaths and health outcomes

When MOUD is available during incarceration and linked to care on release, overdose deaths drop sharply.

A widely cited example comes from Rhode Island, which implemented a statewide corrections program offering all three MOUD medications and linkage to community care. The program was associated with a 61% reduction in opioid overdose deaths among people recently released from incarceration.

Other studies show:

• Lower rates of non-fatal overdose
• Reduced injection-related harms and transmission of HIV and hepatitis C
• Greater engagement in ongoing treatment after release

Recidivism and community reentry

By stabilizing OUD, MOUD can:

• Reduce drug-related criminal behavior
• Support adherence to probation or parole requirements
• Improve capacity to pursue employment, housing, and family responsibilities

Facilities that incorporate MOUD into broader reentry planning such as helping enroll people in Medicaid and scheduling community appointments before release see better continuity of care and lower recidivism.

System-wide and public health benefits

For facilities and communities, MOUD is associated with:

• Safer environments for staff and other incarcerated people, reflecting the importance of correctional health care practices.
• Lower health-care costs linked to untreated OUD
• Safer environments for staff and other incarcerated people

From a public health perspective, treating OUD in jail or prison is often one of the most effective ways to reach people who rarely access outpatient care.

Practical Pathways to Expanding MOUD Access

1. Universal screening and clinical assessment

Best practice is to:

• Screen all individuals at intake for substance use and OUD using validated tools
• Offer a prompt clinical assessment when screening is positive
• Ask about prior MOUD and, where safe and appropriate, continue existing treatment rather than abruptly stopping it

This approach aligns with CDC recommendations on “linkage to care” for people with OUD in high-risk settings.

2. Offering all three FDA-approved medications when possible

Providing methadone, buprenorphine, and naltrexone gives clinicians the flexibility to match medication to clinical need in an addiction treatment clinical trial setting. Facilities that can’t offer all three immediately may start with one medication and build out over time, but the long-term goal should be full formulary access.

3. Building strong community partnerships

Key steps include:

• Formal relationships with local opioid treatment programs and MOUD prescribers
• Warm hand-offs (sharing records, scheduling appointments before release)
• Bridge prescriptions or on-release doses to cover the gap until the first community visit
• Assistance with Medicaid or other insurance enrollment pre-release, where allowed by state policy National Governors Association

4. Training and culture change

Sustainable programs rely on:

• Leadership buy-in from sheriffs, wardens, medical directors, and county officials, as well as new guidance on effective implementation.
• Training for medical staff, custody staff, and reentry teams on OUD as a medical condition and on MOUD protocols
• Clear, written policies that define workflows, security procedures, and communication plans

Resources like SAMHSA’s prison MOUD guidelines and planning toolkits for jails and prisons provide concrete templates and checklists to support this work.

Policy and Funding Considerations

Medicaid and the inmate exclusion policy

The federal Medicaid Inmate Exclusion Policy generally prevents Medicaid from paying for care during incarceration, shifting costs to state and local budgets. Several states, however, are testing waivers that allow limited Medicaid coverage for services provided shortly before release, with the goal of improving continuity of care and outcomes. National Governors Association

Leveraging federal and state resources

Facilities and jurisdictions can explore:

• SAMHSA grants focused on treatment expansion and criminal justice partnerships
• BJA/COSSAP funding to support planning, implementation, and evaluation of MOUD programs
• State opioid settlement funds, where policy allows, to underwrite MOUD in correctional settings

Steps for administrators and policymakers

Practical next steps include:

1. Needs assessment – quantify the scope of OUD and injection drug use in the facility, and map current services. The National Commission’s guidelines can inform best practices here.
2. Phased implementation plan – pilot MOUD in one unit or facility, then scale.
3. Policy revision – update written policies to formally recognize MOUD as standard of care.
4. Data tracking – monitor enrollment, retention, overdose events, and reentry outcomes to guide improvement.

Conclusion

MOUD in jails and prisons is not just a clinical option it is a central public health and civil rights priority in the era of the opioid crisis, particularly in the treatment of opioid use disorder. For many incarcerated individuals, withdrawal, untreated opioid use disorder, and co-occurring conditions such as alcohol dependence create significant medical risks that extend far beyond the jail walls. National health agencies consistently emphasize the same message: providing methadone, buprenorphine, or naltrexone during incarceration and ensuring people remain connected to care after release reduces overdose deaths and improves long-term stability.

For sheriffs, jail medical teams, prison leaders, and county officials, the question is no longer whether MOUD works the evidence is overwhelming. The priority now is designing systems that make MOUD the standard rather than the exception. That includes:

• Screening for opioid use disorder at intake
• Ensuring uninterrupted dosing during incarceration
• Training custody and medical staff in evidence-based MOUD protocols
• Creating stable, predictable transitions to community providers at release

Building these systems requires collaboration between corrections, public health, and community clinicians including physician-led telehealth programs like DevotedDOc that can support continuity of care across county and state lines. When MOUD access follows a person from intake to discharge and into the community, the goals become achievable: fewer preventable deaths, more consistent recovery pathways, and a more humane, evidence-aligned response to one of the justice system’s most urgent health challenges.

If your county jail, DOC agency, or reentry program is exploring evidence-based ways to expand MOUD access, DevotedDOc can support physician-led continuity of care before and after release.
Our team works with sheriffs, jail medical directors, and county health leaders to strengthen transitions, stabilize high-risk individuals, and build sustainable, compliant OUD workflows across Florida, Georgia, Oklahoma City, and New Mexico.

To discuss partnership options or request a program briefing for your facility, connect with DevotedDOc’s clinical leadership team today.