Medications for opioid use disorder in county jails

Support and resources for Sheriff's Offices considering implementation

March 2022

Hundreds of people die of overdose deaths in the United States every day, and people who have been incarcerated are at significant risk for overdose following release, especially within the first two weeks. Evidence suggests that medications for opioid use disorder (MOUD) and corresponding psychosocial services are the gold standard of treatment for opioid use disorder (OUD) and are highly effective at reducing overdose risk and recidivism and promoting long-term and sustainable recovery. County jails serve as a pivotal touchpoint where behavioral health partners can intervene with people who have an OUD by providing access to these medications and services. This resource sheet is intended for local sheriff's offices that want to learn more about best practices for the treatment of OUD and are seeking guidance on how to implement these services in their county jail.

If you are interested in technical assistance from the CBHJ to implement a jail-based medication assisted treatment program, please contact or email us.

The Opioid Treatment Ecosystem

Opioid Treatment Ecosystem logo The Center for Behavioral Health and Justice (CBHJ) at Wayne State University has over a decade of experience facilitating collaboration between criminal-legal partners and behavioral health treatment systems. We currently work with 26 county jail facilities across the state to facilitate these collaborations. With funding from the Michigan Opioid Partnership and the Michigan Health Endowment Fund, the CBHJ started the Opioid Treatment Ecosystem (OTE) initiative in 2019. The goal of the initiative is to foster sustainable alliances with community providers to change the cultural landscape around substance use disorder and decrease overdose deaths through prevention, treatment, harm reduction and sustained recovery.

Evidence-based model for providing medications for opioid use disorder in jails

To provide a framework for implementing MOUD in county jails, the CBHJ developed a model that incorporates evidence-based practices to provide treatment for opioid use disorder (OUD) while incarcerated and to ensure continuity of care post-release. Full implementation of this model includes the use of validated screening tools, access to all three forms of FDA-approved medications for OUD, adjunctive psychosocial services, and development of a continuity of care plan. The CBHJ will provide certification to county jails who sustain at least 90% fidelity to this model for two consecutive months.

Technical assistance to implement medications for opioid use disorder in county jails

The CBHJ provides technical assistance to the county jails who are implementing an MOUD program, including:

Development of opioid use disorder prevalence data within your facility.
Through the implementation of a validated OUD screening tool at the time of booking, the CBHJ can collect and analyze screening data to establish prevalence within the county jail. This data is shared with county partners to develop a data-driven understanding of the need for a robust MOUD program in your facility.
Facilitation of a local Change Team.
Change teams include a variety of local partners who meet at least monthly to discuss implementation and review program data. Change Teams regularly convene with other county-level teams across the state to provide updates, share successes, and help each other overcome common barriers to implementation.
Fidelity monitoring and certification of MOUD program.
Project Coordinators from the CBHJ meet regularly with local Change Teams to monitor progress toward fidelity to the OTE model, which is measured using a 13-item questionnaire. After sustaining fidelity to the model for two consecutive months, the CBHJ will certify your county jail for adhering to its evidence-based OTE model.

Implementation toolkits and additional resources

For jails interested in implementing a new MOUD program

The National Sheriff's Association outlines best practices for implementing MOUD in a jail setting.
The National Institute on Drug Abuse provides an overview of evidence-based practices for treating opioid addiction in criminal justice settings.
Vital Strategies describes concrete steps to plan and implement a jail-based MOUD program.

For jails with existing MOUD programs, the CBHJ has developed several resources on improving practices

The CBHJ's MOUD decision guide provides information on the three forms of MOUD and is intended to help patients make an informed decision about the medication that is best suited for them and to facilitate a conversation about it with the prescribing physician.
The CBHJ's naloxone toolkit is designed to guide Sheriff's Offices, jail administrators, local health departments and community-based organizations in the implementation or expansion of naloxone distribution programs.
OTE Webinars and Lunch & Learns occur on a bi-monthly basis and are focused on topics related to the science of addiction, medications for opioid use disorder, data sharing laws, and harm reduction.
The County Comparisons data dashboard compiles information from numerous data sources, allowing you to explore criminal justice, behavioral health, public health, demographic, housing, population data on your community to make state- or county-level policy decisions, to write a winning grant proposal, or to explore and satisfy your curiosity about a certain topic.