Impact of jail-based methadone or buprenorphine treatment on non-fatal opioid overdose after incarceration

Teena Cherian, Sungwoo Lim, Monica Katyal, Keith S. Goldfeld, Ryan McDonald, Ellen Wiewel, Maria Khan, Noa Krawczyk, Sarah Braunstein, Sean M. Murphy, Ali Jalali, Philip J. Jeng, Zachary Rosner, Ross MacDonald, Joshua D. Lee

Research output: Contribution to journalArticlepeer-review


Background: Non-fatal overdose is a leading predictor of subsequent fatal overdose. For individuals who are incarcerated, the risk of experiencing an overdose is highest when transitioning from a correctional setting to the community. We assessed if enrollment in jail-based medications for opioid use disorder (MOUD) is associated with lower risk of non-fatal opioid overdoses after jail release among individuals with opioid use disorder (OUD). Methods: This was a retrospective, observational cohort study of adults with OUD who were incarcerated in New York City jails and received MOUD or did not receive any MOUD (out-of-treatment) within the last three days before release to the community in 2011–2017. The outcome was the first non-fatal opioid overdose emergency department (ED) visit within 1 year of jail release during 2011–2017. Covariates included demographic, clinical, incarceration-related, and other characteristics. We performed multivariable cause-specific Cox proportional hazards regression analysis to compare the risk of non-fatal opioid overdose ED visits within 1 year after jail release between groups. Results: MOUD group included 8660 individuals with 17,119 incarcerations; out-of-treatment group included 10,163 individuals with 14,263 incarcerations. Controlling for covariates and accounting for competing risks, in-jail MOUD was associated with lower non-fatal opioid overdose risk within 14 days after jail release (adjusted HR=0.49, 95% confidence interval=0.33–0.74). We found no significant differences 15–28, 29–56, or 57–365 days post-release. Conclusion: MOUD group had lower risk of non-fatal opioid overdose immediately after jail release. Wider implementation of MOUD in US jails could potentially reduce post-release overdoses, ED utilization, and associated healthcare costs.

Original languageEnglish (US)
Article number111274
JournalDrug and alcohol dependence
StatePublished - Jun 1 2024


  • Emergency department
  • Jail
  • Medication for opioid use disorder
  • Non-fatal overdose
  • Opioid use disorder
  • Urban population

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


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