With a substantial over­representation of those with medical, mental health, and substance use issues entering our facilities each day, any way to reduce critical incidents and increase safety and security should be researched, evaluated, implemented, and monitored if at all possible. While it is estimated that 1% of the general population meets the diagnostic criteria for an opioid use disorder (OUD), evidence suggests that opioid use is associated with increased involvement in the criminal justice system and that approximately 15% of individuals in U.S. jails have an opioid use disorder (Winkelman et al, 2018; Substance Abuse and Mental Health Services Administration [SAMHSA], 2021; National Academy of Sciences, Engineering, and Medicine, 2019). With consistently limited community resources, jails have become de facto detoxification facilities for individuals using opioids and other illicit substances. The implementation of medication-assisted treatment has the potential to make detention and correctional facilities and communities safer for the public, staff members, arrestees, and incarcerated individuals.

Opioid use disorder is a chronic, treatable condition that can be deadly if left untreated. In 2021, over 80,000 people in the United States died from an opioid overdose, many of which were attributed to fentanyl use (Centers for Disease Control and Prevention, 2022). The risk of overdose is extremely high following release from jail and prison (Borschmann et al, 2018). Medication-assisted treatment can be utilized to prevent adverse health outcomes among incarcerated individuals with OUD within our jails and after their release back into our local communities.

There should also be an initial screening by qualified medical personnel to determine acceptability of the arrestee for booking. This is where individuals will be initially identified as being at risk for withdrawal and a referral for medication assisted treatment may be made. It is important that jail personnel share their observations and concerns with health staff, so they have as much information as possible. The first 24 hours are critical, and the first week is when most issues can be identified, managed or treated, and critical incidents can be prevented.

Once booked, individuals that are addicted to substances (alcohol, opioids, etc.) will be placed on an enhanced watch and have additional contact with health staff. It is critical that custody staff assigned to housing regularly communicate changes they see to health staff. This is where MAT really becomes important and helpful to prevent behavioral and medical problems for this population. Whether it is continuing a program that was ongoing in the community prior to arrest or starting a new prescription to treat a substance use disorder, the medical provider can determine what course will best serve the individual. A reduction in behavioral problems and reduced risk of in-custody death are two benefits that directly impact the individual, staff members, and facility as a whole.

An effective MAT program will include education, medication, counseling, and referral to resources in the community upon release. The jail is a central hub and can promote changes to the entire criminal justice system. Working with the courts, additional requirements and resources can be coordinated for individuals upon release from the jail. Working with local medical and mental health providers can reduce the risks of relapse. Working with police, religious leaders, social service providers, and the local hospitals can fill gaps in service and may even reduce recidivism.

New processes and change can be stressful and difficult to accept, especially in a quasi-military agency charged with