County Jail MOUD Expansion Initiative

Treating OUD in detention facilities presents unique challenges and practices in treating OUD vary across Pennsylvania’s jails. As MOUD becomes more accessible in community settings more individuals enter jail having already received treatment with methadone and buprenorphine. Many others are found to have an OUD while incarcerated and are willing to accept treatment.

Each detention setting can plan for implementation of MOUD informed by established evidence-based and best practices and its own resources, capabilities, and priorities.  Key considerations include developing protocols for initiating and maintaining buprenorphine and methadone and optimizing the delivery of treatment while minimizing opportunities for misuse. Balancing county priorities for MOUD treatment and jail priorities for public safety and contraband is essential. Also, treatment started in the detention setting should be accessible upon release so MOUD services should be developed in collaboration with the community’s outpatient drug treatment system.

This technical assistance (TA) program prepared county teams to improve and expand access to MOUD in local jails and surrounding communities through individual county jail coaching and virtual learning sessions. Goals of the project are to increase county knowledge and understanding of MOUD in the criminal justice system, increase the use of MOUD using evidence-based practices, and promote a county culture that supports MOUD for incarcerated individuals.

This site is a reference for TA program materials for county jails, state correctional institutions, community members, and program partners in the Commonwealth who are expanding and implementing MOUD and those interested in learning more about it.

• HMA Concept Brief – Medication Administration with Diversion Considerations
• Neuroscience of Addiction – This module offers a 25-minute video of the neuroscience of addiction as a chronic brain disease presented by HMA’s Corey Waller, MD, MS, FACEP, DFASAM, with emphasis on Opioid Use Disorder (OUD)
• Medications for Opioid Disorder:  Implementation of Treatment While Incarcerated and For Re-Entry
• De-Mystifying Induction onto Buprenorphine
• Leveraging Lessons Learned from Successful County MOUD Implementations, with guest speakers from Eaton County, MI, and Camden County, NJ
• Refining Approaches to MAT in Jails as Treatment Guidance Evolves
• HMA Flowchart for Medication Administration
• HMA Diversion Pathway
• HMA Sample MAT Policy
• Buprenorphine Medication Administration Training, developed by HMA for Michigan Department of Corrections
• HMA Issue Brief – Optimizing Capacity for Prescribing Buprenorphine in Jails and Prisons
• Overcoming Objections to MAT
• HMA County Touchpoints for Implementation of MAT in Criminal Justice Settings Training Modules and Videos (reference Modules 2-6) 
• Resources from other organizations:
  • California Bridge – Buprenorphine – Naloxone – What you need to know
  • California Bridge – Medicines for Treating Opioid Use
  • Rhode Island Department of Corrections – Med Line for Administering Methadone
  • ASHP Diversion Guidelines
  • Jail Medicine – High Profile Medications for Diversion
  • SAMHSA – MAT Inside Correctional Facilities: Addressing Medication Diversion
  • Prescribing in prison: Minimizing Psychotropic Drug Diversion in Correctional Practice, PubMed article
  • Correctional Nurse – Medication Diversion in Jails and Prisons (Podcast Episode 136)

• HMA Concept Brief – Custody Support and Training
• Leveraging Lessons Learned from Successful County MOUD Implementations, with guest speakers from Eaton County, MI, and Camden County, NJ
• Delaware Department of Correction’s MAT Journey
• The Evolution and Operation of MAT at a Large Urban Jail: Cook County Jail
• Neuroscience of Addiction
• MAT in the Corrections Setting
• Tale of Two Inmates
• HMA County Touchpoints for Implementation of MAT in Criminal Justice Settings Training Modules and Videos (reference Modules 2-6)
• Buprenorphine Medication Administration Training Presentation, developed for Michigan Department of Corrections
• Overcoming Objections to MAT
• Resources from other organizations:
  • Rhode Island Department of Corrections – Developing “Buy-in” with Security and Custody Staff
  • Rhode Island Department of Corrections – Role of Security
  • Providers Clinical Support System – Myths and Misconceptions about MAT
  • Philadelphia Department of Prisons –MAT Education for Inmates
  • Philadelphia Department of Prisons – Custody Officer Delivery of NARCAN PowerPoint Presentation
  • RSAT and TASC – Role of Correctional Officers in Substance Use Treatment

• HMA Concept Brief – Options to Assure Access to Methadone for Treatment of OUD in Jails
• Collaboration Opportunities for County Jails and Opioid Treatment Programs to Support and Expand MOUD services – facilitated discussion with the Pennsylvania Department of Drug and Alcohol Programs
• OTP Application Process
• Resources from other organizations:
  • California Bridge – Medicines for Treating Opioid Use
  • SAMHSA Federal Guidelines for OTPs 2015

• HMA Concept Brief – Continuity of Medications for OUD Post-Release
• Workflow for Bridge Medication upon Release
• Re-Entry in the Time of COVID-19
• HMA County Touchpoints for Implementation of MAT in Criminal Justice Settings Training Modules and Videos (reference Modules 3 and 4) 
• Resources from other organizations:
  • Building Bridges Initiative – Release Flowchart
  • SAMHSA OTP Provider Directory 
  • DDAP Licensure of Drug and Alcohol Facilities 
  • SAMHSA – Behavioral Health Treatment Services Locator
  • SAMHSA – Buprenorphine Practitioner Locator 
  • Healthcare.gov – Provides information and resources to assist connecting individuals who have been incarcerated to health insurance
  • Gains Center – Housing as Critical Component of Reentry
  • Federal Regulation of Methadone Treatment, Institute of Medicine (US) Committee on Federal Regulation of Methadone Treatment; Editors: Richard A. Rettig and Adam Yarmolinsky. Washington (DC): National Academies Press (US); 1995. ISBN-10: 0-309-05240-8

• Glossary – Operational Definitions
• Addiction Treatment in the Justice System: Why now?
• Using Data to Understand and Evaluate MOUD in Jails
• Addressing Co-Occurring Disorders in the Jail Setting
• HMA County Touchpoints for Implementation of MAT in Criminal Justice Settings Training Modules and Videos (reference Modules 2-6): Each module includes information, videos and facilitation guides on the topic. Descriptions of some training modules available at this site are below:
  • Addiction Free CA County Touchpoints Module 2: Addiction Neuroscience 101. This module offers a 25-minute video of the neuroscience of addiction as a chronic brain disease presented by Corey Waller, MD, with emphasis on Opioid Use Disorder (OUD). Discussion questions are provided to help participants consider reactions to this information, which is new to most people.
  • Module 3: The Case for Treating Opioid Addiction in Justice and Human Service Settings This module offers a 29-minute video that briefly reviews the history of addiction treatment in prisons and jails and provides a variety of “cases” for treating OUD in jails, prison, courts, probation/parole, and child welfare. Discussion questions and additional resources are provided to help participants translate this information into action in the workplace.
  • Module 4: MAT Medications: How They Work, For Whom, Implications for Use in Criminal Justice and Human Service Settings This module offers a 56-minute video that provides information, in understandable terms, about FDA-approved medications for treatment of OUD. Method of action, abuse potential, patients most appropriate for the medication, side effects, common myths, and considerations for use in jails are addressed for each medication.
  • Module 5: Overcoming Barriers to MAT This module offers a 14-minute video in which stakeholders in criminal justice reflect on how they overcame skepticism about the use of MAT in jails and probation, and their experiences with using it. It includes commentary from two persons with OUD who received MAT.
  • Module 6: Your Profession and MAT This module translates general information about treating OUD in justice settings to specific client activities and approaches that reflect current best practice information and approaches and includes two videos: 1) senior leaders from multiple CJ agencies  reflect on how their professions have changed to address addiction as a chronic brain disease and to accept and adapt to the role of MAT in treating OUD; (2) “Tale of Two Inmates” that illustrates the similarities and differences that two persons with OUD experienced in the justice system.
• Resources from other organizations:
  • Vital Strategies – Medication Treatment for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit
  • ASAM – Supporting People with Addiction in Criminal Justice Settings During COVID
  • Dell Medical Center – Reducing Stigma Educational Tools (Reducing Stigma Educational Tools (ReSET))
  • Legal Action Center, NY – Myths and Facts about MAT 
  • ASHP – Preventing Diversion of Controlled Substances 
  • Jail Medicine – High Profile Medications for Diversion
  • SAMHSA – MAT Inside Correctional Facilities: Addressing Medication Diversion
  • PubMed Article – Prescribing in prison: Minimizing Psychotropic Drug Diversion in Correctional Practice
  • Vital Strategies – Medication Treatment for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit