Potential health impacts of comprehensive access to opioid use disorder treatment in United States correctional facilities: A synthetic analysis.

Smith JJ, Noonan M, Johnson CE, Humphreys K, Gupta R. Potential health impacts of comprehensive access to opioid use disorder treatment in United States correctional facilities: A synthetic analysis. Addiction (Abingdon, England). 2025 Nov 3 DOI: 10.1111/add.70170.

Related HSR&D Project(s)

• RCS 04-141 – Evaluating Treatment & Self-help Methods of Improving Functioning & Quality of Life Outcomes of Patients with Substance Abuse Disorders

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Abstract:

BACKGROUND AND AIMS: Providing comprehensive access to medications for opioid use disorder (MOUD) for people transitioning from United States (US) jails and prisons is important to addressing the substance use disorder (SUD) epidemic. Such policies have augmented public health in other countries, but a precise estimate of its potential impact in the US is lacking. This study sought to estimate: (1) the annual number of opioid overdose deaths (OODs) among individuals released from US jails and prisons, and (2) the number of OODs preventable by providing comprehensive MOUD programs in carceral settings and linkage to care post-release. METHODS: Nationally weighted synthetic estimates of opioid overdose mortality incidence rates among people released from US jails and prisons in a given year were calculated using mortality rates obtained from published studies. Previously published mortality rates were adjusted, using state-year multipliers, to account for temporal variation among study cohorts. Adjusted rates were weighted and combined to produce synthetic national estimates, then rescaled to reflect national OOD patterns from 2017 to 2022. These rescaled mortality rates were then applied to US jail and prison release statistics to estimate the annual number of OODs among the recently incarcerated. Estimates of MOUD efficacy 12 months post-release were used to estimate the number of potential lives saved through expanded MOUD access. RESULTS: We estimate that 21,784 people [95% synthetic confidence interval (SCI) 18,425 to 25,142] released from US jails and prisons in 2022 died from opioid overdose that year, constituting 27% of annual OODs nationwide. If all jails and prisons provided SUD screening upon entry, MOUD while incarcerated and linkage to care upon release, we estimate that 13,288 OODs (95% SCI 11,239 to 15,337), or 16% of the national total, may have been prevented in 2022. CONCLUSIONS: Approximately 27% of opioid overdose deaths in the United States in 2022 occurred among individuals recently released from carceral settings. Expanding access to medications for opioid use disorder to people in custody and those recently released could potentially prevent a substantial portion of opioid overdose deaths in the United States.