Cost-Effectiveness of Providing Medications for Opioid Use Disorder during Incarceration

April 25, 2023

Rates of opioid use disorder are disproportionately high among those who are incarcerated. Additionally, people leaving jails and prisons are at an elevated risk for overdose, in part because forced withdrawal during incarceration can lead to a diminished tolerance for opioids.

Accordingly, numerous organizations–including the National Academy of Medicine, the American Society for Addiction Medicine, and the National Commission on Correctional Health Care–all recommend that jails and prisons offer all three medications (methadone, buprenorphine and naltrexone) approved to treat opioid use disorder during the period of incarceration and connect people to care upon release. However, the vast majority of correctional facilities do not offer any of the medications.

A recent study simulated the health outcomes, financial costs, and cost effectiveness of three potential scenarios among correctional facilities: providing no medications, providing just naltrexone (the medication most commonly used in correctional facilities), and providing all three medications. As jurisdictions are considering opportunities for opioid settlement funds, they should consider two key points from the paper.

First, their simulation found that providing all three medications was superior to providing just naltrexone across all outcomes, including treatment initiations, treatment retention, and overdose deaths prevented. The authors attributed this to the much higher retention rates with buprenorphine and methadone when compared to naltrexone.

Second, the authors concluded that providing all three medications was “a highly cost-effective intervention.” In particular, the strategy of using all three medications shifted spending from incarceration to treatment.

The authors conclude that, “The findings of this economic evaluation and modeling study suggest that offering MOUD during incarceration could prevent opioid overdose deaths, with a strategy including all 3 forms of MOUD being particularly impactful and cost-effective.”

This study provides additional encouragement for state and local policymakers to use money from the opioid litigation to fund treatment programs in correctional facilities that provide all three medications to treat opioid use disorder. States including Rhode Island and Vermont have pioneered such an approach. Elsewhere, county jails including those in Allegheny County and Franklin County in Pennsylvania have taken the lead.

Jails and prisons that have wanted to provide medications to treat opioid use disorder have faced many barriers to getting these programs started. For many facilities, the cost of launching such a program may be prohibitive. Accordingly, this study provides additional encouragement for state and local policymakers to use money from the opioid litigation to fund treatment programs in correctional facilities that provide all three medications to treat opioid use disorder.

In addition to the financial barrier, facilities that have wanted to provide methadone or buprenorphine have also faced barriers due to Drug Enforcement Administration regulations around the medications. However, Congress recently removed the requirement that practitioners get a special waiver in order to prescribe buprenorphine. This will greatly increase the number of providers in both correctional and community settings who can use a buprenorphine to treat people with an opioid use disorder.

Additionally, a recent report outlined how jails and prisons can use methadone to treat people in the same way that hospitals do. This approach is more straightforward than contracting with or becoming an opioid treatment program, the two options that correctional facilities have traditionally used. Facilities that are interested in pursuing this approach should email OverdosePrevInit@jh.edu.

Overall, this new research paper and the new policy approaches to using buprenorphine and methadone make a compelling case for states and localities to use money from the opioid litigation to save lives.