Jail-Based MAT
Jail Guidelines for the Medical Treatment of Substance Use Disorders 2025
NCCHC’s new resource, Jail Guidelines for the Medical Treatment of Substance Use Disorders 2025, provides the latest research and best practices for addressing the opioid crisis and ensuring that incarcerated individuals receive effective treatment. This publication incorporates up-to-date, evidence-based recommendations for implementing and evaluating medication-assisted treatment (MAT) programs, along with insights into the evolving regulatory landscape.
To support informed decision-making and the adoption of evidence-based practices in jail-based MAT programs, this guide offers:
- A structured overview of the key stages of MAT program implementation, designed for clarity and conciseness without sacrificing essential details.
- An analysis of regulations governing MAT in correctional settings.
- References to additional resources for deeper exploration of specialized topics not covered in detail.
- Case studies showcasing real-world examples of successful MAT programs.
In 2018, NCCHC partnered with the National Sheriffs’ Association to develop Jail-Based MAT: Promising Practices, Guidelines, and Resources. Since then, the landscape of substance use disorder treatment in jails and the broader community has evolved significantly. Despite a growing legal mandate to provide MAT, many agencies still face knowledge gaps that hinder effective program implementation.
Endorsed by the American Jail Association and the National Sheriffs’ Association, this new publication equips correctional facilities with the tools needed to navigate these challenges and expand access to life-saving treatment.
WHAT’S NEW IN THIS EDITION
Jail-based treatment for substance use disorders has evolved since 2018, when Jail-Based Medication-Assisted Treatment was published. Now, more jails offer access to methadone, buprenorphine, and/or naltrexone. In addition, the legal landscape has evolved to elevate the standard of care that jails are required to meet. Meanwhile, increasingly lethal drugs have become common, and the number of overdoses remains high in the United States. With this update, NCCHC seeks to capture this evolution while maintaining the goals of the original publication. This version includes a change in structure, updated research, and new resources, as well as changes to specific content that our working group deemed necessary to accurately reflect the current landscape of jail-based MAT treatment. Notable updates include the following:
Terminology
Humanizing language and a nonstigmatizing approach to addiction elevates the understanding of substance use disorders as chronic diseases. Furthermore, justice-involved individuals often face stigma during and after incarceration that can lead to dehumanizing treatment and adverse outcomes. NCCHC promotes the use of humanizing, person-first language to describe people who are incarcerated. The authors intended to avoid stigmatizing language. However, preferred language changes over time and differs by perspective. We acknowledge that the language used here may not be considered correct by all.
“Medication-assisted treatment” (MAT) and “medications for opioid use disorder” (MOUD) are commonly used to describe buprenorphine, methadone, and naltrexone, the three medications for the treatment of opioid use disorder (OUD) approved by the Food and Drug Administration (FDA). However, MOUD excludes medications for the treatment of alcohol use disorder (AUD), a condition that is highly prevalent among jail and prison populations. “MAT” is commonly used and understood by jail administrators, custody staff, and health staff in correctional facilities to refer to addiction treatment and encompasses both OUD and AUD treatments. For these reasons, we have chosen to continue using the acronym MAT but intend for it to mean “medications for addiction treatment,” to include treatment for both OUD and AUD.
Regulatory Changes
Buprenorphine and Methadone
In 2023, major regulatory changes were made regarding buprenorphine prescribers. 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 regardless of whether they intend to prescribe buprenorphine or not. Furthermore, there is no longer a cap on the number of patients that practitioners are allowed to treat with buprenorphine. Thus, any physician, nurse practitioner, physician assistant, or nurse midwife with an active, unrestricted DEA license can prescribe buprenorphine in the absence of state restrictions.
In 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced regulatory updates expanding the definition of long-term care facilities, with implications for methadone prescribing for correctional facilities that register with the DEA as a hospital/clinic. More information is provided in the methadone section of this document. States may also apply for a Medicaid reentry Section 1115 waiver demonstration project to benefit those leaving jails and prisons.
Over-the-Counter Naloxone
Naloxone is a medication that rapidly reverses the effects of opioid overdose. In 2023, the FDA approved naloxone for over-the-counter, nonprescription use.
Opioid Treatment Programs (OTPs)
In 2024, SAMHSA announced regulatory updates regarding OTPs. This document reflects the status of OTP regulations at the time of publishing.
COMPONENT 1 – SCREENING
Receiving screening should be conducted Immediately upon acceptance into jail custody. Screeners should explain the reason for the questions (e.g., “We ask these questions to ensure you receive appropriate treatment while you are here”). Questions should address physical and mental health, prescribed medications, including MAT, previous drug or alcohol treatment, recent drug or alcohol use including types and amount, and current or past history of drug or alcohol withdrawal. 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.
Clinical assessments for MAT begin with a general screening and assessment for SUDs, allowing treatment to be tailored to a person’s problem substances and often helping to reduce the amount of medication needed. People who acknowledge that they have used opioids should be asked about frequency, amount, route, concomitant use of other substances, and history of withdrawal and overdose.
COMPONENT 2 – MEDICATION CHOICE
People receiving prescribed MAT should be allowed to continue their medication when this is the patient’s wish and is clinically appropriate. This means that jails need to provide access to all three FDA-approved medications. In addition, the selected medication must be matched to the needs of the individual. Table 1 provides further details on each medication.
Uncertainty regarding the length of detention should not necessarily deter initiation of buprenorphine or methadone since the induction could be continued following release. XR-NTX requires an opioid-free period (i.e., withdrawal) of 7 to 10 days from short-acting opioids and 10 to 14 days for long-acting opioids. Therefore, people opting for this treatment should be informed of the risk of overdose if they are released before the drug can be given.
COMPONENT 3 – PARTNERSHIPS, COMMUNICATION, AND COLLABORATION
The ways in which jails provide access to MAT will vary depending on the facility’s resources, location, community resources, health services vendor, and leadership, among other factors. Evidence-based practice dictates that all three FDA-approved medications be available and that medication choice is not influenced or directed by correctional administrators.
Health and custody staff should receive education and training on OUD and AUD, nonstigmatizing language, MAT, and facility policies and procedures related to the treatment. It is important to provide opportunities for staff to communicate feedback and concerns regarding the MAT program in order to garner buy-in from those involved in ensuring high quality care, to continuously improve program delivery, and to ensure ongoing success. Interdisciplinary coordination between health and custody staff is crucial. For example, administration of oral buprenorphine commonly includes a nurse to administer the medication and conduct mouth checks to ensure the medication has dissolved and a custody staff member to monitor for attempts at diversion.
COMPONENT 4 – DISCHARGE PLANNING AND POSTRELEASE ASSISTANCE
Time of release from jail can be difficult to predict. Thus, discharge planning must begin at intake and continue throughout incarceration. At the very least, the facility should ensure that a newly released individual has an appointment with, or a warm handoff to, a community provider to continue MAT. If receiving buprenorphine, they should leave the facility with a prescription or a bridge dose of medication to avoid any disruption in treatment. Methadone may also be provided upon release through an OTP, or by the facility, in accordance with federal and state laws and regulations. When possible, patients should go directly from the correctional facility to the community-based treatment center.
Not everyone receiving MAT will be ready for long-term recovery. Education on risk of overdose postrelease and access to FDA-approved opioid reversal drugs (e.g., naloxone, nalmefene) is important. In May 2023, the FDA approved the first nalmefene hydrochloride nasal spray to treat acute opioid overdose (available with a prescription). All individuals with OUD and, if feasible, everyone being released, should leave the facility with an opioid reversal drug. To prevent a fatal overdose, the individual should be educated on when and how to administer these lifesaving drugs. To enhance family preparedness, some jails provide opioid reversal drugs and education on use to family members during visitation.
COMPONENT 5 – CONTINUOUS QUALITY IMPROVEMENT
A CQI program enables 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. A CQI program is an important aspect of health services in jails and, when applied to a MAT program, will offer insights that may otherwise go unnoticed. This allows for improvements to be made to processes and outcomes.