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August 27, 2025
Quarterly Article
ASHLY E. JORDAN
RABIAH GAYNOR
CAROL MOORES
YOLANDA CANTY
CHINAZO O. CUNNINGHAM
Aug 27, 2025
Apr 29, 2025
June 2024
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Policy Points:
See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do?
In the United States, substance use disorder (SUD) is a significant public health and public safety challenge.1-3 Up to two-thirds of individuals who are incarcerated meet SUD criteria, compared with 16.7% of the general population.4, 5 Individuals who have opioid use disorder (OUD) are also overrepresented in criminal legal settings: approximately 15.0% to 30.0% of individuals who are incarcerated have OUD, compared with 3.7% of the general population.6 Furthermore, individuals who are incarcerated are at high risk for fatal overdose both inside carceral facilities and upon reentry to the community.7 Overdose is the third leading cause of death in jails, and overdose deaths have increased more than six times over the past two decades in prisons.8, 9 Among those reentering the community, fatal overdose is the leading cause of death. The risk of fatal overdose within the first two weeks following reentry is more than 100 times higher than in the general US population.8-10
Medication for OUD (MOUD) is first-line OUD treatment, which improves health and social outcomes including reducing the risk of overdose death by more than 50.0%.11-13 Providing MOUD during incarceration and at reentry into the community is a cost-effective approach to improve OUD treatment outcomes and to reduce overdose death.12-17 Despite this, MOUD treatment in most US jails and prisons and at reentry has been limited.18 Because approximately 60.0% of US jails and prisons do not offer MOUD,19, 20 incarceration events frequently result in delays in initiating MOUD, disruptions in continuity of already initiated MOUD, and risk of fatal overdose.8, 21-23
United Nations Office on Drugs and Crime. World Drug Report 2024. UNDOC; 2024.
GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859-1922.
Prison Policy Initiative. Punishment beyond prisons 2023: incarceration and supervision by state, appendix. 2023. Accessed November 9, 2024. https://prisonpolicy.org/reports/correctionalcontrol2023_data_appendix.html
Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH). Updated February 13, 2025. Accessed May 10, 2025. https://samhsa.gov/data/release/2023-national-survey-drug-use-and-health-nsduh-releases
Nall SK, Jurecka C, Ammons A, et al. Identifying structural risk factors for overdose following incarceration: a concept mapping study. Health Justice. 2024;12(1):11.
Dowell D, Brown S, Gyawali S, et al. Treatment for opioid use disorder: population estimates—United States, 2022. MMWR Morb Mortal Wkly Rep. 2024;73(25):567-574.
Binswanger IA, Nguyen AP, Morenoff JD, Xu S, Harding DJ. The association of criminal justice supervision setting with overdose mortality: a longitudinal cohort study. Addiction. 2020;115(12):2329-2338.
Fiscella K, Noonan M, Leonard SH, et al. Drug- and alcohol-associated deaths in U.S. jails. J Correct Health Care. 2020;26(2):183-193.
Carson EA. Mortality in state and federal prisons, 2001-2018—statistical tables. Bureau of Justice Statistics. April 29, 2021. Accessed May 10, 2025. https://bjs.ojp.gov/library/publications/mortality-state-and-federal-prisons-2001-2018-statistical-tables
Binswanger IA, Blatchford PJ, Mueller SR, Stern MF. Mortality after prison release: opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009. Ann Intern Med. 2013;159(9):592-600.
Larochelle MR, Bernson D, Land T, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality. Ann Intern Med. 2018;169(3):137-145.
Jordan AE, Kashino W, Suhartono S, Campello G, Busse A. A systematic review and narrative synthesis of interventions to address substance use disorders and other mental health disorders in prison settings with a focus on low- and middle-income countries. Crim Justice Behav. 2023;50(6):787-805.
Howell BA, Martin RA, Lebeau R, et al. Changes in health services use after receipt of medications for opioid use disorder in a statewide correctional system. Health Aff (Millwood). 2021;40(8):1304-1311.
Brinkley-Rubinstein L, Peterson M, Clarke J, et al. The benefits and implementation challenges of the first state-wide comprehensive medication for addictions program in a unified jail and prison setting. Drug Alcohol Depend. 2019;205:107514.
Moore KE, Roberts W, Reid HH, Smith KMZ, Oberleitner LMS, McKee SA. Effectiveness of medication assisted treatment for opioid use in prison and jail settings: a meta-analysis and systematic review. J Subst Abuse Treat. 2019;99:32-43.
Degenhardt L, Larney S, Kimber J, et al. The impact of opioid substitution therapy on mortality post-release from prison: retrospective data linkage study. Addiction. 2014;109(8):1306-1317.
Cherian T, Lim S, Katyal M, et al. Impact of jail-based methadone or buprenorphine treatment on non-fatal opioid overdose after incarceration. Drug Alcohol Depend. 2024;259:111274.
Pivovarova E, Evans EA, Stopka TJ, Santelices C, Ferguson WJ, Friedmann PD. Legislatively mandated implementation of medications for opioid use disorders in jails: a qualitative study of clinical, correctional, and jail administrator perspectives. Drug Alcohol Depend. 2022;234:109394.
Sufrin C, Kramer CT, Terplan M, et al. Availability of medications for the treatment of opioid use disorder among pregnant and postpartum individuals in US jails. JAMA Netw Open. 2022;5(1):e2144369.
Scott CK, Grella CE, Dennis ML, Carnevale J, LaVallee R. Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S. Health Justice. 2022;10(1):36.
Zhao J, Star J, Han X, et al. Incarceration history and access to and receipt of health care in the US. JAMA Health Forum. 2024;5(2):e235318.
Lim S, Cherian T, Katyal M, et al. Association between jail-based methadone or buprenorphine treatment for opioid use disorder and overdose mortality after release from New York City jails 2011-17. Addiction. 2023;118(3):459-467.
Martin RA, Alexander-Scott N, Berk J, et al. Post-incarceration outcomes of a comprehensive statewide correctional MOUD program: a retrospective cohort study. Lancet Reg Health Am. 2022;18:100419.
