Providing MOUD in Jails: A Key Strategy Against Overdose & Recidivism

A new NIH-funded study has shown compelling evidence that giving people medication for opioid use disorder (MOUD) while incarcerated dramatically improves outcomes after release — including reducing overdose deaths, lowering mortality, and slightly decreasing reincarceration. National Institutes of Health (NIH)

Here’s what you need to know, especially if you work in treatment, corrections, or legal compliance in behavioral health.

What the Study Found

• The research followed about 6,400 individuals in seven Massachusetts county jails (between September 2019 and December 2020), all with probable opioid use disorder. National Institutes of Health (NIH)

• Roughly 42% received MOUD while incarcerated; the others did not. National Institutes of Health (NIH)

• Key outcomes for those who got MOUD in jail compared to those who did not:

  • 52% lower risk of fatal opioid overdose after release National Institutes of Health (NIH)

  • 24% lower risk of non-fatal opioid overdose National Institutes of Health (NIH)

  • 56% lower risk of death from any cause National Institutes of Health (NIH)

  • 12% lower risk of reincarceration after release National Institutes of Health (NIH)

• Treatment engagement post-release was much better: people who received MOUD in jail were far more likely to stay in treatment during the critical first months after release. For example, 57.5% of those treated in jail were still on MOUD six months later vs. 22.8% of those who didn’t receive it in jail. National Institutes of Health (NIH)

Why This Matters Legally & Clinically

This kind of study has big implications for providers, correctional systems, policy makers, and legal advisors. Here are the takeaways:

1. Standard of Care & Best Practices

   • MOUD in incarceration settings is increasingly supported by data as best practice. Providers and correctional health programs need to consider integrating MOUD (buprenorphine, methadone, naltrexone) into jail settings where feasible.

2. Regulatory and Policy Pressure

   • As data supports better outcomes, funding agencies, regulators, and courts may increasingly expect that incarcerated individuals receive MOUD. Not doing so could become a liability or a target for litigation or policy mandates.

3. Contracts, Grants & Compliance

   • Suppose you are a provider contractually obligated (or wanting to be) to deliver care in criminal justice settings. In that case, contracts should explicitly address MOUD, release planning, continuity of care, and community linkages. Legal compliance efforts should ensure these deliverables are met.

4. Risk Minimization

   • For providers outside jails, this suggests that refusing or failing to offer MOUD can increase risk: for clients (overdose, death), for liability, for reputational harm. Ensuring continuity of care and avoiding gaps is essential.

5. Patient Care & Ethical Dimensions

   • From an ethical perspective, denying effective, evidence-based treatment due to logistical or budgetary constraints may be increasingly viewed as neglectful, especially when consequences are life threatening.

What Should Behavioral Health Providers & Legal Counsel Do

Based on the study’s findings, here are some action items:

• Audit your MOUD offering: If you provide care in correctional settings, check whether MOUD is offered, whether it begins in incarceration, and whether people are linked with community care after release.

• Review internal policies to ensure MOUD is included, with documentation, protocols, and staff training.

• Legal review of contracts & funding to ensure MOUD obligations are clear, and that funding supports the continuity of care (pre-release, post-release).

• Monitor state and county laws or regulations, because some may have begun (or will begin) to require or strongly encourage MOUD in correctional settings.

• Prepare for oversight & possible litigation: Collect data to show your outcomes, continuity, and compliance; this can serve both mission and legal protection.

Lynne Legal’s Perspective

This NIH study reinforces what many in behavioral health have long argued: treatment doesn’t wait for release. Carceral settings are crucial intervention points. For legal advisors and providers alike, the key is to anticipate that MOUD-in-jail will become less optional and more of an expected standard of care.

If your organization is involved (or planning to be) in correctional health, reentry services, or community-linked care, now is a strategically important moment to ensure your legal structure, documentation, contracts, and compliance are aligned.