Medications for Opioid Use Disorder in County Jails — Outcomes after Release

TO THE EDITOR:

Friedmann et al. (Sept. 11 issue)¹ confirm and add data to decades of research: provision of medications for opioid use disorder (MOUD) in carceral settings saves lives, reduces the risk of reincarceration, and improves public health outcomes.² Despite this evidence, implementation still lags. Recent national data indicate that fewer than half of U.S. jails provide any MOUD, with only 13% offering all three Food and Drug Administration (FDA)–approved medications.³ Forced withdrawal during incarceration reduces subsequent treatment continuation and increases the risk of fatal overdose by as much as 80% after release.⁴

This neglect persists despite clear legal precedent: courts have found that denying MOUD violates the Americans with Disabilities Act and the Eighth and Fourteenth Amendments. The “prison implementation penalty” — the persistent lag in adopting evidence-based interventions in correctional systems — contributes not only to untreated addiction but also to untreated mental illness and other health conditions.⁵

Failure to implement evidence-based addiction treatment in correctional facilities is no longer defensible. The science is settled; what remains is the political and moral will to act.