Optimizing the impact of medications for opioid use disorder at release from prison and jail settings: A microsimulation modeling study

Int J Drug Policy. 2021 May;91:102841. doi: 10.1016/j.drugpo.2020.102841. Epub 2020 Jul 22.


Background: We examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality.

Methods: We developed a microsimulation model to simulate a population of 55,000 persons at risk of opioid-related overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017-2024) were compared to the standard of care (i.e., limited access to MOUD).

Results: In the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively.

Conclusions: Expanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, at-risk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.

Keywords: Jails; Medications for opioid use disorder; Opioids; Overdose; Prisons.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Buprenorphine*
  • Humans
  • Jails
  • Opioid-Related Disorders* / drug therapy
  • Prisons
  • Rhode Island


  • Buprenorphine