JCOIN Project Expands Access to Life-Saving Medications for Opioid Use Disorder in Jails

Findings from JCOIN’s Coordination and Translation Center

 

Overdose is the leading cause of death for people recently released from jail or prison, with individuals within two weeks of their date of release being 12–40 times more likely to die than other residents of the states studied.1,2 Research shows that individuals treated at a correctional facility with buprenorphine or methadone medications for opioid use disorder (MOUD) had lower mortality rates, were less likely to be reincarcerated, and were more likely to be employed one year after release. Moreover, providing access to all three FDA-approved MOUDs (buprenorphine, methadone, and naltrexone) could reduce overdose deaths in this high-risk population by almost 32%. 

Despite the considerable public health opportunity, jails and prisons have been slow to use MOUDs. When they do, access is often highly restricted, limited to pregnant women, those already on regimen before incarceration, or those initiating MOUD immediately before release. These barriers persist despite policy initiatives and technical assistance efforts to expand MOUD use in correctional settings. This study aimed to design a more effective technical assistance model to help jails implement MOUDs and enhance public safety.

The JCOIN trial tested three technical assistance approaches to determine their effectiveness in increasing MOUD use in 29 county jails and by 21 affiliated community-based providers spanning 14 states, from Hawaii to Maine to Florida. The approaches included high-intensity organizational coaching, low-intensity organizational coaching, and Extension for Community Healthcare Outcomes (ECHO), a case study learning approach for clinicians. Results showed that high-dose organizational coaching was the most effective approach. However, its impact was not significantly different from low-dose organizational coaching, which proved to be the most cost-efficient. 

Across all coaching approaches, MOUD use among incarcerated individuals with an opioid use disorder increased by 45% over one year, showing a dramatic increase. The improvement was achieved by coaches helping sites activate the cascade of care, which includes: 

  • increasing screening rates 
  • increasing the types of MOUDs offered 
  • improving MOUD treatment initiation processes inside jails
  • enhancing patient safety 
  • improving the handoff from the jail to continuing care through community-based MOUD providers


The trial demonstrated that while implementing MOUDs in correctional settings can be difficult, providing coaching to assist with setting up or improving the cascade of care will increase access to these life-saving treatments. The study was published in Implementation Science and conducted by Dr. Todd Molfenter, Jessica Vechinski, Jessica Tveit, Dr. Jee-Seon Kim, Jingru Zhang, and Lionel Meng from the University of Wisconsin, Dr. Lynn Madden from Yale School of Medicine and the APT Foundation, and Dr. Faye S. Taxman from George Mason University.

 

References:

  1. Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison—A high risk of death for former inmates. The New England Journal of Medicine, 356(2), 157–165. https://doi.org/10.1056/NEJMsa064115
  2. Ranapurwala, S. I., Shanahan, M. E., Alexandridis, A. A., Proescholdbell, S. K., Naumann, R. B., Edwards, D., Jr., & Marshall, S. W. (2018). Opioid overdose mortality among former North Carolina inmates: 2000–2015. American Journal of Public Health, 108(9), 1207–1213. https://doi.org/10.2105/AJPH.2018.304514