Elizabeth Evans

Limited access to medications for opioid use disorder (MOUD) is a major driver of the opioid overdose crisis. Jails have been slow to implement MOUD treatment, especially agonist medications (methadone, buprenorphine). Massachusetts mandated certain county jails pilot-test delivery of all FDA-approved MOUD treatments, stipulating jails continue MOUD, or initiate it prior to release, and facilitate MOUD continuation in the community post-release. The Massachusetts Justice Community Opioid Innovation Network (MassJCOIN) partnered with seven pilot jails, the Massachusetts Department of Public Health, and community treatment providers to conduct a Type 1 hybrid effectiveness-implementation study of this carceral MOUD program. Drawing from selected MassJCOIN evidence on MOUD treatment program implementation, outcomes, and costs, we consider how findings can inform more effective, humane public health and clinical responses to treating incarcerated individuals. MOUD treatment in jail improves treatment engagement, reduces recidivism, and saves lives. MOUD program implementation facilitators included: policies and processes to offer universal MOUD access ; transformative and adaptive leadership ; appropriate staffing capacity and capabilities ; proactive prevention of MOUD diversion ; and consideration of patient preferences for MOUD treatment and co-occurring mental health conditions . MOUD program success was influenced by the legislative mandate and other major statewide changes and a community-based treatment system conducive to MOUD implementation. MOUD treatment continuity post-release was facilitated by re-entry planning and preparing individuals for post-release risk environments . Site-specific costs of implementing and sustaining MOUD programming provide information for decisions about program design, budgetary needs, and resource allocation. Carceral MOUD programming is a compelling strategy to advance public safety and public health. Lessons learned provide a playbook for broader diffusion of carceral MOUD programs and can help carceral leadership, healthcare providers, and policymakers make carceral healthcare improvements. Within a harm reduction framework, carceral MOUD treatment can provide substantial opportunities to fill gaps in public health prevention efforts and clinical care to reduce opioid overdose and other concomitant risks. Carceral MOUD programming offers ways for carceral systems to work for the common good, garner trust in public institutions, and increase their legitimacy and value as public institutions.

The United States continues to see high numbers of fatal opioid overdoses (Ahmad et al., 2023). In Massachusetts (MA), the fatal opioid overdose rate rose 2.5% from 2021 to 2022, with an estimated ...

Dantuluri examines the ongoing prescription stimulant shortage driven by the Drug Enforcement Administration’s quota restrictions and an ineffective and fragmented system of drug governance. We extend this analysis to carceral health systems, which operate under similar logics of control in managing risks, diversion, and liability around medications for opioid use disorder. In drawing these parallels, we explore how perceptions of risk, suspicion, and restrictive oversight can produce scarcity, reinforce stigma, and elicit judgments around “deservingness” that may ultimately widen treatment gaps. We conclude with actionable recommendations that align with public health ethics to promote equitable access to evidence-based treatment.

People who use drugs face barriers to accessing HIV prevention tools. The status-neutral model for HIV care starts with the HIV test and offers linkage to

Background: Although research on Medications for Opioid Use Disorder (MOUD) in carceral settings has grown, it has largely focused on the implementation of medication delivery or on substance use outcomes in the community. However, the introduction of new programs or the expansion of treatment services in criminal legal settings can have both direct and indirect consequences on other treatment programs and correctional operations within jails. Mental health and substance use disorders frequently co-occur, and their psychosocial treatment components often overlap. We examined how the implementation of MOUD in all jails across Massachusetts impacted the mental health services operating within the jails and the requirements for substance use counseling alongside MOUD. Methods: We conducted semi-structured interviews ( n = 47) and focus groups ( n = 42) with staff from 13 county jails as part of an implementation of MOUD in jails study. Using deductive and inductive coding, all transcripts were double-coded and analyzed using a modified framework method. Results: We identified five key themes about the perceived impact of MOUD on mental health and substance use counseling services. First, MOUD implementation was perceived to reduce acute mental health crises, such as risk for suicide, and the demand on mental health services at intake to the facility. Second, staff perceptions about the effectiveness of MOUD as a stand-alone treatment influenced their decisions about the need for and interpretation of substance use counseling requirements. Third, the required components of substance use counseling created a need for additional staff, which exacerbated the existing shortage of mental health staff. Fourth, infrastructure limitations and privacy needs made the delivery of substance use counseling logistically challenging in jail settings. Finally, MOUD implementation increased interdisciplinary collaboration in some jails by requiring medical, mental health, and substance use providers to work together to resolve the needs of incarcerated individuals. Conclusions: As jails aim to meet regulatory requirements for MOUD, they will need to manage potential staffing shortages, infrastructure constraints, and shifts in the mental health and substance use counseling services. Guidelines for implementing MOUD in carceral settings should also consider the unintended consequences of MOUD on other behavioral health services.

In 2019, seven county correctional facilities (jails) in Massachusetts initiated pilot programs to provide all Food and Drug Administration-approved medications for opioid use disorder (MOUD). This observational study used linked state data to examine postrelease MOUD receipt, overdose, death, and reincarceration among persons with probable opioid use disorder (OUD) in carceral settings who did or did not receive MOUD from these programs from September 1, 2019, through December 31, 2020. Log-binomial and proportional-hazards models were adjusted for propensity-score weights and baseline covariates that remained imbalanced after propensity-score weighting. The study cohort included 6400 persons with probable OUD: 2711 (42.4%) received MOUD in jail and 3689 (57.6%) did not. Among persons treated with MOUD in jail, 67.9% received buprenorphine, 25.7% received methadone, and 6.5% received naltrexone. Treated persons were more likely than those not treated to be White (75.4% vs. 58.1%), to be sentenced (31.6% vs. 13.2%), to be receiving MOUD at jail entry (73.7% vs. 17.1%), and to receive MOUD during the first 30 days after community release (60.2% vs. 17.6%; adjusted relative risk, 1.44; 95% confidence interval [CI], 1.38 to 1.50). Only 50.4% of MOUD recipients engaged in MOUD treatment for 75% of the first 90 days after release, and 57.5% were receiving MOUD at 180 days. Receipt of MOUD in jail, as compared with no such receipt, was associated with lower postrelease risks of fatal overdose (adjusted hazard ratio, 0.48; 95% CI, 0.36 to 0.64), nonfatal overdose (adjusted hazard ratio, 0.76; 95% CI, 0.68 to 0.85), death from any cause (adjusted hazard ratio, 0.44; 95% CI, 0.35 to 0.56), and reincarceration (adjusted hazard ratio, 0.88; 95% CI, 0.81 to 0.94). The incidence of hospitalizations did not differ substantially between the two groups. Receipt of MOUD in jail was associated with an increased likelihood of postrelease MOUD initiation and decreased risks of overdose, death from any cause, and reincarceration. (Funded by the National Institutes of Health and others.).

Purpose The rise of fatal stimulant use among adults who use opioids is a public health problem. Internalized stigma is a barrier to substance use treatment, which is greater for women and populations with criminal justice involvement. Methods Using a nationally representative sample of adults in the United States from a probability-based survey on household opinions in 2021, we examined characteristics of women (n = 289) and men (n = 416) who misuse opioids. In gender-stratified multivariable linear regression, we investigated factors associated with internalized stigma, and tested for the interaction of stimulant use and criminal justice involvement. Results Compared to men, women reported greater mental health symptom severity (3.2 vs. 2.7 on a 1 to 6 scale, p < 0.001). Internalized stigma was similar between women (2.3 ± 1.1) and men (2.2 ± 0.1). Among women and not men, however, stimulant use was positively associated with internalized stigma (0.36, 95% CI [0.07, 0.65]; p = 0.02). Interaction between stimulant use and criminal justice involvement was negatively associated with internalized stigma among women (− 0.60, 95% CI [− 1.16, -0.04]; p = 0.04); among men, the interaction was not significant. Predictive margins illustrate among women, stimulant use eliminated the gap in internalized stigma such that women with no criminal justice involvement had a similar level of internalized stigma as women with criminal justice involvement. Conclusion Internalized stigma between women and men who misuse opioids differed based on stimulant use and criminal justice involvement. Future research should assess whether internalized stigma influences treatment utilization among women with criminal justice involvement.