May 1, 2025

Policy and procedural challenges at U.S. jails are the top barriers that limit them from providing medications for opioid use disorder (MOUD) to all inmates with opioid use disorder (OUD). In a nationally representative survey of jails that provided MOUD to some inmates during 2023, more than three-quarters said policies and procedures affected the jail’s ability to provide buprenorphine (cited by 78.7%) and methadone (cited by 73.5%) to all inmates with OUD. Barriers posed by policies and procedures included concerns about Drug Enforcement Administration regulations; state, county, or jail policies and regulations; concerns about security and diversion; policies restricting who is able to receive medication; funding or cost; and need to obtain licensure as an opioid treatment program. In addition to citing problems due to policies and procedures as a barrier to providing universal to MOUD, two-thirds of jails cited logistics for obtaining the medications as a barrier, cited by 63.3% of jails for buprenorphine and 64.9% of jails for methadone.

Of the jails surveyed, 27.6% provided all three types of MOUD—buprenorphine, naltrexone, and methadone. About 65.3% of all the jails surveyed provided buprenorphine, 52.0% provided naltrexone, and 45.0% provided methadone.

Staff availability is the biggest facilitator for MOUD, helping 70% of jails provide buprenorphine and 50.4% of jails provide methadone. Policy and procedures can be a benefit, and assisted 64.2% of jails provide buprenorphine, and 50.3% of jails provide methadone.

To help with MOUD provision, 60.7% of jails overall indicated a need for additional medical staff. The most common technical assistance needs for MOUD provision included staff education (57.0%) and connecting to community resources (52.1%). The most common training needs for providing MOUD were forming community linkage partnerships (45.4%) and partnering with community-based opioid treatment programs (33.4%). Another 37.3% of jails said they need help addressing stigma and negative attitudes toward MOUD.

These findings were presented in Barriers to Universal Availability of Medications for Opioid Use Disorder in U.S. Jails, by Elizabeth Flanagan Balawajder, MPH; Lori Ducharme, Ph.D.; Bruce G. Taylor, Ph.D.; Phoebe A. Lamuda, SM; and colleagues. The researchers conducted a survey of jails from February 2 through July 1, 2023. The survey was administered via mail, telephone, and online survey link. A total of 265 jails that provided MOUD were included in the analysis, representative of 1,243 jails nationwide after weighting. The goal was to examine the types of MOUD that jails make available, factors associated with availability, and additional supports needed for MOUD implementation.

The full text of Barriers to Universal Availability of Medications for Opioid Use Disorder in U.S. Jails was published April 16, 2025, by JAMA Network Open. A free copy is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2832851 (accessed April 24, 2025).