Budget Impact Tool for the Incorporation of Medications for Opioid Use Disorder into Jail/Prison Facilities

By: Bonnie Tse

February 8, 2023


Despite evidence that medications for opioid use disorder (MOUD), namely methadone, buprenorphine, and naltrexone, provided at the point of incarceration improve the well-being of the individual and the public, financial and administrative limitations in jail/prison healthcare often serve as barriers to this recommended first-line treatment for OUD. In fact, evidence indicates that more than 80% of incarcerated individuals with a history of OUD do not receive life-saving medications during their stay.

Fortunately, there has been a substantial increase in the number of jails and prisons offering MOUD in recent years. This trend can be attributed to both the initiative of individual facilities and state legislation mandating the provision of MOUD. However, the resources and associated costs required to implement MOUD programs in jails and prisons can vary widely depending on the availability of services and the chosen delivery model.

Danielle Ryan, lead author and program manager at Weill Cornell Medicine, and CHERISH authors including Techna Cadet, data analyst at Weill Cornell Medicine, Kathryn E. McCollister, CHERISH Methodology Core director, and Sean M. Murphy, CHERISH Methodology Core co-director, developed a customizable budget impact tool to assist jails and prisons with identifying an optimal MOUD delivery model, based on existing resources, and the costs that would be required to implement and sustain the model at their facility.

“Our tool captures critical nuances of the individualized budgeting process and accompanying tradeoffs faced by decision-makers of carceral settings who are interested in offering MOUD,” Ryan shared. “For example, facilities may be looking to offer pharmacotherapy for the first time or expand a current model, such as offering extended-release naltrexone upon release from incarceration only. Moreover, MOUD delivery can be done by the facility’s healthcare team, on-site vendor, or both. Alternatively, facilities may transport patients to an off-site treatment provider.”

The budget impact tool, which was already being used by a number of carceral facilities, is now publicly available and paired with an open-access, peer-reviewed manuscript that serves as a user-friendly guide.

Read the open-access article published on January 26, 2023, in the Journal of Substance Use and Addiction Treatment.

The Budget Impact Tool for The Incorporation of Medications for Opioid Use Disorder into Jail/Prison Facilities is available for download on our resources page. Additional guidance on how to use the tool can be requested through the CHERISH Consultation Service.