Many US jails lack nearby access to opioid treatment programs, study shows

A new study led by researchers at Brown University School of Public Health found that more than half of U.S. jails are located at least a 30-minute drive from the nearest opioid treatment program - a distance that may make it harder for incarcerated people to receive methadone, a key medication for opioid addiction.

The research letter, published in JAMA Network Open, analyzed 3,228 nonfederal jails and 2,096 federally licensed opioid treatment programs, or OTPs. The team from Brown, led by health policy researcher Brendan Saloner, along with collaborators at the Johns Hopkins Bloomberg School of Public Health, found that 51.5% of jails were more than a half-hour away from the closest program.

"Jail has historically been really bad for overdose risk - people go in, withdraw and then come out and overdose," said Saloner, a professor in Brown's Department of Health Services, Policy and Practice.

Providing medications for opioid use disorder during incarceration has been shown to reduce the risk of death after release. But methadone, one of the most effective treatments, is tightly regulated and typically must be dispensed through licensed treatment programs, forcing many jails to rely on outside clinics to supply daily doses.

If you leave a problem untreated in jail, we as taxpayers are going to end up paying for it later. There needs to be a concerted effort to get access to methadone outside of this OTP model where these treatment programs aren't available or able to be a partner because of distance."

Brendan Saloner, Professor in Brown's Department of Health Services, Policy and Practice

The requirement that methadone must be dispensed through OTPs creates logistical challenges for jails - which are short-term facilities that hold people awaiting trial or serving brief sentences - that do not have a program on-site.

"It's a trip that has to get made every day," Saloner said. "Jail staff have to go out, pick up the methadone and bring it back."

The study found a median driving time of about 31 minutes nationwide, but access was far more limited in rural areas. Jails in rural counties were an average of 85 minutes from the nearest treatment program, compared with about 11 minutes in large urban counties. The longest distances were concentrated in parts of the Great Plains as well as in states such as Nevada and Alaska.

"We can't expect every jail to send staff out on long drives to make this work," Saloner said. "That's not a feasible solution." 

Saloner pointed out that recent federal regulations offer correctional facilities a different pathway that could help solve the problem. 

"Jails have the ability to register as a hospital or clinic and dispense their own methadone to qualified patients," Saloner said. "Getting more jails to follow this model could make a huge difference which is why our team is supporting more facilities to adopt this model."