Opioid use and overdose deaths have quickly become a national epidemic. On average, a shocking 187 people die in the United States every day from opioid overdose. [1] This problem is pervasive and often makes its way into the criminal justice system.
At this point, corrections personnel are likely already familiar with inmates struggling with substance or opioid use disorder. How can jails effectively address opioid use disorder (OUD), while maintaining the safety of the facility and ensuring protection of inmates’ constitutional rights? A Medications for Opioid Use Disorder (MOUD) program offers a tangible solution for many jails. As MOUD becomes more viable – and increasingly expected – it’s time to evaluate how it may fit into your facility’s programs.
In a recent webinar, “Medications for Opioid Use Disorder (MOUD): Critical Considerations for Your Jail Facility,” Robert Simon and Richard Forbus from the National Commission on Correctional Health Care (NCCHC) and Dr. Nikki Johnson from the Denver Sheriff Department discuss the justification, challenges and key components of a successful MOUD program in jails and other correctional facilities.
What is MOUD?
What does MOUD consist of? And what does it look like in a jail setting?
“Medications for Opioid Use Disorder” programs are just what they sound like – a program that provides a variety of medications to address individuals’ struggles with opioid addiction.
You may have heard of Medication-Assisted Treatment (MAT) programs, which provide a similar service and typically combine a single medication with counseling and other therapeutic interventions. MOUD programs place greater emphasis on pharmaceutical intervention, offering a variety of medications, as studies have shown that even programs offering medication alone can be incredibly effective.
MOUD programs include medications such as methadone, buprenorphine, naltrexone and naloxone, which all support rehabilitation efforts for inmates struggling with OUD. These medications block, ease, or alleviate withdrawal symptoms; block the activity of opioid receptors in the brain to prevent the euphoric effects of opioid use; or reverse the effects of an overdose. Having various medications in a MOUD program is essential to its success, as it allows treatment to be specific to the needs of the inmate with OUD.
Note: Different levels of certification and/or accreditation are required to incorporate specific medications into the program. To run a MOUD program without methadone, jails must adhere to state pharmacy regulations and be certified by their accrediting body. Correctional facilities that would like to incorporate methadone in their MOUD program must be accredited by the NCCHC and certified by SAMHSA. Either way, developing an MOUD program is an important step for progressive jails seeking to ensure effective treatment of inmates, in keeping with their constitutional rights.
The case for MOUD in jails
MOUD programs have proven successful, both in correctional facilities and in the community. Within correctional facilities, we have an opportunity to provide critical health care for inmates suffering from OUD, resulting in better outcomes within and outside of the jail. Evidence shows that MOUD programs in jails positively impact inmate behavior, stabilizing inmate moods and reducing levels of depression. This in turn results in increased safety and security for inmates, correctional personnel and the community as a whole.
Additionally, having an in-jail MOUD program increases the likelihood that rehabilitative programming will be continued post-release, reducing recidivism and reducing the chance of opioid overdose within the first two weeks following release from the correctional facility. [2,3]
The overall trend in corrections is toward MOUD programs – for good reason. Research from the NCCHC found that, as of 2022, approximately 60% of correctional facilities offer some form of MOUD, while 15% of facilities have MOUD programs that include methadone. [4]
Legal trends affirm the importance of implementing a MOUD program: In recent years, facilities have faced lawsuits for failure to provide MOUD, with charges alleging violations of the Eighth Amendment and the Americans with Disabilities Act (ADA). MOUD programs are also included in updated law enforcement and healthcare best practices, and there has been movement at the state level to support the implementation of these programs within jails.
Getting buy-in
As with any program in corrections, MOUD programs require collaboration and buy-in from the top down. Correctional facilities must seek to educate personnel, inmates and the community to reduce the stigma around OUD and provide a clear picture of the benefits of treatment through an MOUD program. Additionally, jails should ensure clear understanding of how MOUD programs can positively impact inmate health, facility safety and security, and the community at large. Collaboration can only take place when people at all levels, including in your community, are on board.
To learn more about MOUD and how it works in a jail setting, view the on-demand webinar, “Medications for Opioid Use Disorder (MOUD): Critical Considerations for Your Jail Facility.”
References
1. Understanding the opioid overdose epidemic. (2023.) Centers for Disease Control and Prevention.
2. Hartung DM, McCracken CM, Nguyen T, Kempany K, Waddell EN. (2023.) Fatal and nonfatal opioid overdose risk following release from prison: A retrospective cohort study using linked administrative data. Journal of Substance Use and Addiction Treatment.
3. ONDCP Releases Report on Substance Use Treatment in Correctional Settings to Save Lives, Reduce Costs. (2023.) The White House.
4. As reported by Richard Forbus, vice president of program development, NCCHC, in a recent Lexipol webinar: https://info.lexipol.com/webinar-moud.