Table 1.
Jail-based medication for opioid use disorder implementation checklist (N = 16).
| Implementation checklist items | Baseline | Follow-up | Change |
|---|---|---|---|
| n (%) | n (%) | n (%) | |
| Screening for opioid use disorder (OUD) | |||
| Using a standardized protocol | 12 (75%) | 15 (94%) | 3 (19%) |
| Only in a special population for opioid use disorder | 2 (13%) | 5 (31%) | 3 (19%) |
| In all inmates | 14 (88%) | 12 (75%) | −2 (−13%) |
| Our organization does not currently screen for OUD | 2 (13%) | 2 (13%) | 0 (0%) |
| Providing OUD medication treatment plans | |||
| Provides OUD medication treatment plans tailored to the needs of inmates | 8 (50%) | 11 (69%) | 3 (19%) |
| Provides OUD medication treatment plans based on inmate preferences | 6 (38%) | 8 (50%) | 2 (13%) |
| Provides OUD medication treatment plans based on medications available in the community | 7 (44%) | 11 (69%) | 4 (25%) |
| Provides OUD medication treatment plans that coordinate with community treatment providers | 8 (50%) | 13 (81%) | 5 (31%) |
| Provides OUD medication treatment plans coordinated with community corrections (e.g., probation, drug courts) | 8 (50%) | 11 (69%) | 3 (19%) |
| Provides OUD medication treatment plans that ensures halfway/transitional houses accept people on OUD medications | 6 (38%) | 11 (69%) | 5 (31%) |
| The organization does not provide OUD treatment plans | 4 (25%) | 2 (13%) | −2 (−13%) |
| Continuing inmates on MOUDs | |||
| Continues community extended-release naltrexone | 6 (38%) | 11 (69%) | 5 (31%) |
| Continues community buprenorphine | 7 (44%) | 10 (63%) | 3 (19%) |
| Continues community methadone | 10 (63%) | 8 (50%) | −2 (−13%) |
| Does not continue community OUD medications | 4 (25%) | 6 (38%) | 2 (13%) |
| Initiating medically managed withdrawal | |||
| Provides medically managed withdrawal with methadone to those out of care experiencing opioid withdrawal | 5 (31%) | 2 (13%) | −3 (−19%) |
| Provides medically managed withdrawal with buprenorphine to those out of care experiencing opioid withdrawal | 3 (19%) | 6 (38%) | 3 (19%) |
| Initiates methadone maintenance to those out of care with opioid withdrawal symptoms | 5 (31%) | 5 (31%) | 0 (0%) |
| Initiates buprenorphine maintenance to those out of care with opioid withdrawal symptoms | 4 (25%) | 7 (44%) | 3 (19%) |
| Provides non-opioid medications for withdrawal symptom management (e.g., clonidine, lofexidine, ondansetron) | 12 (75%) | 14 (88%) | 2 (13%) |
| Does not provide any medications for withdrawal | 4 (25%) | 5 (31%) | 1 (6%) |
| MOUD induction prior to release | |||
| Provides naltrexone (e.g., extended-release or oral) induction prior to release | 10 (63%) | 11 (69%) | 1 (6%) |
| Provides methadone induction prior to release | 1 (6%) | 3 (19%) | 2 (13%) |
| Provides buprenorphine induction prior to release | 6 (38%) | 8 (50%) | 2 (13%) |
| Provides other medications prior to release | 3 (19%) | 9 (56%) | 6 (38%) |
| Does not start any OUD medications prior to release | 5 (31%) | 4 (25%) | −1 (−6%) |
| Guidelines for dose induction | |||
| Has medical guidelines to conduct methadone dose induction for patients with opioid withdrawal | 1 (6%) | 7 (44%) | 6 (38%) |
| Has medical guidelines to conduct methadone dose induction for patients who are not opioid tolerant | 0 (0%) | 6 (38%) | 6 (38%) |
| Has medical guidelines to conduct buprenorphine dose induction for patients with opioid withdrawal | 5 (31%) | 11 (69%) | 6 (38%) |
| Has medical guidelines to conduct buprenorphine dose induction for patients who are not tolerant | 4 (25%) | 11 (69%) | 7 (44%) |
| Has medical guidelines to conduct extended-release naltrexone dose induction | 7 (44%) | 13 (81%) | 6 (38%) |
| Our organization does not have medical guidelines in place to conduct dose induction | 8 (50%) | 2 (13%) | −6 (−38%) |
| Medical guidelines to treat withdrawal, intoxication, & overdose | |||
| Has medical guidelines to treat precipitated withdrawal from buprenorphine | 8 (50%) | 11 (69%) | 3 (19%) |
| Has medical guidelines to treat precipitated withdrawal from extended-release naltrexone | 8 (50%) | 11 (69%) | 3 (19%) |
| Has medical guidelines to treat opioid intoxication/overdose | 12 (75%) | 14 (88%) | 2 (13%) |
| Has medical guidelines to treat precipitated withdrawal | 2 (13%) | 4 (25%) | 2 (13%) |
| Does not have medical guidelines to treat opioid intoxication/overdose | 3 (19%) | 3 (19%) | 0 (0%) |
| Medical guidelines for medication taper | |||
| Has guidelines to taper methadone for inmates transferred to a controlled environment without this medication | 6 (38%) | 8 (50%) | 2 (13%) |
| Has guidelines to taper buprenorphine for inmates transferred to a controlled environment without this medication | 5 (31%) | 9 (56%) | 4 (25%) |
| Does not have medical guidelines to taper medications for transferred inmates | 7 (44%) | 0 (0%) | −7 (−44) |
| Procedures for compliance | |||
| Has procedures in place to prevent diversion of methadone | 9 (56%) | 12 (75%) | 3 (19%) |
| Has procedures in place to prevent diversion of buprenorphine | 7 (44%) | 13 (81%) | 6 (38%) |
| Has procedures in place to ensure compliance with DEA regulations | 12 (75%) | 14 (88%) | 2 (13%) |
| Has procedures in place to ensure compliance with state drug control regulations | 13 (81%) | 14 (88%) | 1 (6%) |
| Does not have procedures in place to ensure prevention or compliance | 3 (19%) | 2 (13%) | −1 (−6%) |
| Community tracking & connections | |||
| Tracking outcomes for entry into community treatment following release | 6 (38%) | 8 (50%) | 2 (13%) |
| Tracking outcomes for retention in treatment | 4 (25%) | 5 (31%) | 1 (6%) |
| Tracking recidivism (re-arrest) | 4 (25%) | 7 (44%) | 3 (19%) |
| Tracking post-release overdose | 3 (19%) | 5 (31%) | 2 (13%) |
| Does not track outcomes post-release | 8 (50%) | 6 (38%) | −2 (−13) |
| Assists inmates in obtaining or resuming health insurance coverage | 12 (75%) | 11 (69%) | −1 (−6%) |
| Has formal agreements to coordinate care with community treatment programs | 10 (63%) | 10 (81%) | 0 (0%) |
| Staffing | |||
| Has fostered support among custody staff surrounding OUD medications | 9 (56%) | 13 (81%) | 4 (25%) |
| Has fostered support among case management staff surrounding OUD medications | 8 (50%) | 12 (75%) | 4 (25%) |
| Has fostered support among our medical staff surrounding OUD medications | 13 (81%) | 12 (75%) | −1 (−6%) |
| Employs enough properly licensed treatment providers to deliver OUD medications | 7 (44%) | 10 (63%) | 3 (19%) |
Notes. Baseline data collection in August 2019 at the start of the Bridges planning initiative. Follow-up data collection in March and April 2020 at the end of the planning initiative.