Table 1.
MassJCOIN evidence on implementation, outcomes, and costs of program to provide medications for opioid use disorder (MOUD) in county jails
| Author | Year | Study type | Data source | EPIS | Main findings/implications | Principles & context |
|---|---|---|---|---|---|---|
| Evans et al. [6] | 2022 | 1 | Jail staff | 1 | With appropriate protocols, buprenorphine diversion within jail MOUD programs is perceived to be uncommon and preventable by jail staff. Promising practices in program design help limit diversion and inform correctional officials and lawmakers as they consider if and how to provide MOUD treatment in carceral settings. | Stigma reduction; Increasing access to evidence-based care |
| Evans et al. [7] | 2023 | 1 | Patients | 1 | Formerly incarcerated patients perceived MOUD diversion within jail programs as occurring less often than expected and able to be reduced with appropriate protocols. To help limit diversion, patients recommended provision of MOUD upon intake to all individuals with opioid use disorder who need it. | Evidence-based, humane healthcare; Low barrier care; Therapeutic approaches |
| Santelices et al. [8] | 2025 | 1 | Patients | 1 | Participants stressed that MOUD programs should be patient-centered and guided by patients’ symptoms and needs, rather than by policies that postpone or limit care. | Patient-centered care, humane treatment; Therapeutic approach |
| Santelices et al. [unpublished observations] | 2026 | 1 | County sheriffs | 1 | Implementation of jail-based MOUD programs depends on sheriffs’ transformative and adaptive leadership capacity. Successful implementation strategies relied on promoting staff engagement and buy-in, navigating funding and policy, and strengthening interagency collaboration to secure reentry resources and continuity of care post release. | Stigma reduction; Build institutional capacity for evidence-based, humane care; Treatment continuity |
| Pivovarova et al. [9] | 2022 | 1 | Jail staff | 1, 2 | Implementation of MOUD in jails requires flexibility, and collaboration with and reliance on external agencies. Leaders and policymakers must recognize the cultural shift inherent in such programs and allow for resources and education to assure program success. | Stigma reduction; Build institutional capacity for evidence-based, humane care |
| Michener et al. [10] | 2024 | 3 | Jail staff | 1 | Findings underscore the importance of organizational climate for successful implementation of jail MOUD programs and provide support for medication-specific educational resources to improve jail staff perceptions of MOUD. | Stigma reduction; Build institutional capacity for evidence-based, humane care |
| Stopka et al. [12] | 2024 | 1 | Patients | 1 | Understanding patient preferences can inform protocols in jails considering implementation of long-acting injectable buprenorphine treatment. If used in response to medication diversion, efforts should be made to include patients in decision-making. | Patient-centered, humane care |
| Pivovarova et al. [13] | 2025 | 1 | Jail staff | 1 | MOUD implementation in jails was perceived to reduce acute mental health crises and the demand for mental health services at jail intake. As jails work to meet MOUD regulatory requirements, leadership will need to manage potential staffing shortages, infrastructure constraints, and shifts in counseling services. Guidelines should consider unintended consequences of MOUD on other behavioral health services. | Holistic, patient-centered care; Humane treatment |
| Pivovarova et al. [16] | 2025 | 1 | MOUD provider staff | 2 | Community-based MOUD providers identified agency staffing, culture, and adaptability, community support, intentional relationship-building, and effective communication as essential for jail partnerships. Establishing key jail contacts, opportunities for cross-agency education and engagement, and support from other organizations can mitigate challenges posed by fragmented jail services and differing priorities. | Stigma reduction; Centering the dignity of people who use drugs |
| Matsumoto et al. [17] | 2022 | 1 | Jail staff | 3 | Post-release MOUD continuity of care requires training staff in reentry planning, and resources to enhance internal collaboration and partnerships between jail and community MOUD programs. Efforts to reduce systemic barriers related to unanticipated release timing and health insurance reinstatement are needed to optimize seamless post-release care. | Stigma reduction; Treatment continuity; Overdose risk reduction; Social determinants of health (SDOH) & structural barriers |
| Stopka et al. [18] | 2022 | 1 | MOUD provider staff | 3 | Community-based MOUD provider staff highlight the need for investments in care coordination, staffing, and funding to strengthen jail-to-community-based MOUD treatment, removing barriers to care continuity, and decreasing opioid overdose deaths during this high-risk transition. | Stigma reduction; Treatment continuity; Overdose risk reduction; SDOH |
| Stopka et al. [19] | 2026 | 1 | Patients | 3 | Patients recognized the high risk of MOUD treatment lapses during transitions from jail to community reentry, and valued MOUD continuity services initiated during incarceration and continued post-release. Variation in patient-reported quality of reentry planning services underscored the need for more standardized investment in re-entry and treatment continuity services. | Treatment continuity; Overdose risk reduction; Social determinants of health & structural barriers |
| Michener et al. [20] | 2025 | 1 | Patients | 3 | Patients identified physical, social, economic, and policy drivers of post-release overdose. Early MOUD induction during incarceration with continued treatment upon release, peer-driven harm reduction, and community reentry support were reported to be protective against overdose risk. | Evidence-based, humane care; Overdose reduction; SDOH & structural barriers |
| Friedmann et al. [21] | 2025 | 2 | Linked administrative data | All | Receipt of MOUD in jail was associated with an increased likelihood of post-release MOUD initiation and decreased risks of overdose, death from any cause, and reincarceration. MOUD implementation in carceral settings, potentially facilitated by opioid settlement funds and other policy initiatives, can reduce overdose, mortality, and reincarceration among people with OUD involved in the criminal- legal system. | Evidence-based, humane care; Overdose, mortality, and overall risk reduction |
| Ryan et al. [22] | 2023 | 3 | Jail staff | 1, 2 | The budget impact tool can help jail/prison leadership, policymakers, and other stakeholders identify/estimate the resources, costs, and relative effectiveness associated with various MOUD delivery models, and consider potential downstream cost offsets of successful treatment. | Impact policy to expand access to evidence-based, humane care |
| Ryan et al. [24] | 2025 | 3 | Jail staff | 1, 2 | Based on a cost analysis of three different models of jail MOUD program delivery, actionable insights for pre-implementation jails include engaging with similar jails that have implemented MOUD, building relationships with community-based MOUD treatment providers, and educating and training staff on OUD. | Impact policy to expand access to evidence-based, humane care |