NCCHC Introduces New Jail Guidelines for the Medical Treatment of Substance Use Disorders

Claire Wolfe, MPH, CCHP

In many communities across the country, jails are the largest providers of substance use and mental health treatment. Over the past several years, programs that provide access to medication-assisted treatment (MAT) for incarcerated individuals with opioid use disorder (OUD) have been implemented in many jurisdictions. Still, a recent study published in 2024 found that less than half the jails surveyed offered the medications at all (Flanagan et al., 2024).

The National Commission on Correctional Health Care (NCCHC) recently released a new resource, Jail Guidelines for the Medical Treatment of Substance Use Disorders 2025, that provides the latest research and best practices for addressing the opioid crisis and ensuring that incarcerated individuals receive effective treatment. This free publication, endorsed by the American Jail Association and the National Sheriffs’ Association, incorporates up-to-date, evidence-based recommendations for implementing and evaluating MAT programs, along with insights into the evolving regulatory landscape.

The new resource provides a crucial update to Jail-Based MAT: Promising Practices, Guidelines and Resources, which NCCHC published in partnership with the National Sheriffs’ Association in 2018. Since then, much has changed in the field of correctional health care and in the treatment environment for substance use disorders, in terms of both attitudes and regulations.

The nation, however, continues to experience a high number of annual opioid-related overdose deaths due to an incredibly lethal drug supply. Annual overdose deaths from synthetic opioids (i.e., fentanyl) decreased between 2022 and 2023, infusing a glimmer of hope into the picture and providing validation for those pursuing solutions to the opioid crisis. However, age-adjusted overdose death rates among non-Hispanic Black people increased in that same time period, and the overall number of deaths remains historically high (Garnett & Miniño, 2024).

NCCHC recognizes the urgency of continuing to advance evidence-based strategies towards reducing these deaths, providing accessible treatment, and helping those affected by substance use disorders live self-directed lives. To that end, NCCHC has revised the 2018 publication to provide the field with a current, evidence-based resource on providing MAT. Many facilities struggle with funding, policy development, and logistical barriers. This updated publication aims to equip jail administrators and correctional health care professionals with the knowledge and tools needed to navigate these challenges and create sustainable, effective treatment programs.

To encourage informed consideration and support for evidence-based practices related to the provision of jail-based MAT, this new document offers:

  • Information on the various stages of a MAT program, organized clearly with an intent to be concise without sacrificing information and quality
  • Current understanding of the regulations related to the provision of MAT
  • Citation of resources that delve deeply into specific topics not discussed in depth in the guide
  • Sections on special populations: MAT for pregnant people and youth
  • Case studies of existing programs, presenting real-world examples that readers can learn from

Key Changes and Recommendations

The new resource addresses several notable regulatory changes at the federal level that took place in 2023 and 2024. The 2025 guidelines reflect the current understanding of those policies.

Importantly, prescribers no longer need to obtain an X-waiver to prescribe buprenorphine. Instead, all clinicians must complete educational requirements prior to applying for or renewing a Drug Enforcement Administration (DEA) registration. Naloxone was made available over the counter and, more recently, new rules were released that govern how methadone is provided in jails and from community-based opioid treatment programs (OTPs). The 2025 guidelines, using the current evidence base as a foundation, also provide an updated perspective on treating substance use disorders in jails.

Key recommendations include:

  • All individuals should be systematically screened for substance use disorders at intake using validated screening tools. Individuals showing evidence of intoxication or who report MAT or past or current drug or alcohol use should be immediately referred to medical personnel for further evaluation.
  • Those individuals already prescribed methadone or buprenorphine prior to incarceration should have their prescription verified and medication continued in a timely manner.
  • All three FDA-approved MAT medications—methadone, buprenorphine, and naltrexone—should be available in the jail or through an established partnership with a community opioid treatment program. Information on all three medications is available in a handy table.
  • The model of medication delivery will vary based on facility size, community resources, leadership, and partnerships.
  • Treatment, including medication choice, is the result of a shared decision-making process between patient and provider and is not imposed by facility policy. The medication must be matched to the needs of the individual.
  • Training on OUD, alcohol use disorder (AUD), and MAT policies should be offered for both health and custody staff. Interdisciplinary collaboration is crucial to ensure proper medication administration, safety, and program success.
  • Policies and procedures need to be in place to prevent and address medication diversion. These may include supervision of medication administration, patient education, appropriate responses to suspected diversion, and incorporation of diversion into the continuous quality improvement program.
  • The facility coordinates an appointment with, or a warm handoff to, a community provider to continue MAT for newly released individuals. Education on risk of overdose postrelease and access to FDA-approved opioid reversal drugs (e.g., naloxone, nalmefene) is essential.
  • A CQI program is important for staff to identify health care aspects to be monitored, to implement corrective action plans when necessary, and to study the effectiveness of corrective action plans. This allows for improvements to be made to processes and outcomes.

The new guidelines transform these high-level recommendations into a detailed guide for jail and health care leadership, and include suggestions for further resources that go more in-depth on specific and related topics.

AJA Endorsement

Jail Guidelines for the Medical Treatment of Substance Use Disorders 2025 reflects the evolving landscape of substance use disorder treatment in correctional settings. By integrating the latest research, regulatory updates, and evidence-based practices, this publication can be used as a resource for jail leaders and health care professionals working to address the role of the facility in the country’s current health care, policy, and social environment. Implementing these guidelines can help jails improve health outcomes, reduce recidivism, and reduce legal liability.

Jail Guidelines for the Medical Treatment of Substance Use Disorders 2025 is available for free download from NCCHC at ncchc.org/jail-based-MAT/.

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Claire Wolfe, MPH, CCHP, is a program manager at NCCHC Resources, Inc., NCCHC’s consulting subsidiary. She provided project management and administrative support to the development of Jail Guidelines for the Medical Treatment of Substance Use Disorders 2025. Ms. Wolfe brings a diverse skill set in data collection and analysis, advocacy, and program management to NCCHC Resources. Reach her at clairewolfe@ncchcresources.org

References

Flanagan Balawajder E, Ducharme L, Taylor BG, et al. Factors Associated With the Availability of Medications for Opioid Use Disorder in US Jails. JAMA Netw Open. 2024;7(9):e2434704. doi:10.1001/jamanetworkopen.2024.34704

Garnett MF, Miniño AM. Drug overdose deaths in the United States, 2003–2023. NCHS Data Brief, no 522. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc/170565