Few Jails Offer OUD Medications to All Who Need Them

Elizabeth Flanagan Balawajder, M.P.H., a senior research associate in public health at NORC (formerly known as the National Opinion Research Center) at the University of Chicago, and colleagues analyzed survey responses from 927 jails that were weighted to represent 3,157 jails nationally (prisons were not included). The survey featured 23 multiple-choice questions on jail characteristics and health care offerings.

Overall, 70.1% of jails surveyed offered some type of substance use disorder support such as a 12-step program or services for co-occurring substance use and mental health conditions by a licensed clinician. Yet only 43.8% offered at least one type of OUD medication, and not always to everyone who may have needed it. For example, among jails that offered buprenorphine, 71.5% offered the medication to people who were already taking it when booked, but only 40.1% offered it to pregnant individuals, 27.5% offered it to anyone with an OUD who requested it, and 23.3% offered it to people who were about to be released. Only 12.8% of all jails surveyed had at least one medication for OUD available to anyone who requested one.

“It is hard to believe but true that in 2024, with all the evidence that [medications for OUD] are associated with reduced death in persons with OUD and the incredibly high level of diagnosed individuals in our jail and community settings, we continue to see a lack of provision of these lifesaving medications to people who need and want them,” Sandra Springer, M.D., a professor of medicine at Yale School of Medicine, wrote in an invited commentary. “The medications work, but we as a society need to help remove barriers for people to access these evidenced-based medications wherever they are to end the opioid overdose epidemic now.”

The researchers used the CDC’s 2020 Social Vulnerability Index summary ranking to assess the socioeconomic characteristics of the counties in which the jails were located. The index ranks counties based on 16 social factors, including poverty level, unemployment, education, housing, and transportation.

The analysis showed that jails in areas of greater social vulnerability were less likely to provide OUD medications. However, the overdose mortality rate of each jail’s county was not associated with the availability of OUD medications.

“[H]igher social vulnerability levels being associated with lower availability of [medications for] OUD in jails emphasizes the connection with contextual factors in the community,” Balawajder and colleagues wrote. “Because the external environment is associated with the ability to receive [medications for] OUD within the jail and after release, a highly vulnerable time for someone recovering from an OUD, our findings underscore that efforts to improve access to treatment are dependent on shared resources and relationships across public safety and public health contexts.”

The jails that did not offer medications for OUD but reported offering some type of treatment for substance use disorder noted several reasons for not offering these medications:

“These data points speak to the challenges jails face in offering these medications and may suggest how to start to make them available to more people,” Balawajder told Psychiatric News. ■