Four years after Colorado passed a law requiring county jails to provide medications for opioid use disorder (MOUD) and to publish their policies for MOUD care, researchers at the University of Colorado Anschutz have found that many jails still lack publicly available policies explaining how they provide this lifesaving treatment.

The study, published last week in Health & Justice, reviewed opioid treatment policies from all 46 county jails in Colorado. Researchers found that nearly 40% of jails had no publicly available policies related to opioid use disorder (OUD). Among those that did provide policies, fewer than half indicated they offered all three FDA-approved medications used to treat opioid addiction.

"State legislation is an important first step, but policies also need to be transparent, comprehensive and consistently implemented," said Katherine LeMasters, PhD, MPH, senior author of the study, assistant professor of medicine at CU Anschutz and the Colorado School of Public Health. "Publicly available policies can help healthcare providers, families and community organizations better support people during incarceration and after they're released."

People with opioid use disorder are disproportionately represented in U.S. jails and face an especially high risk of overdose after release. Research has shown that medications such as methadone, buprenorphine and extended-release naltrexone reduce overdose deaths, improve recovery and decrease the likelihood of returning to jail.

Colorado's Fentanyl Accountability and Prevention Act, passed in 2022, requires county jails to develop and publish opioid treatment policies, offer medications for opioid use disorder to eligible individuals and help connect people with treatment after release.

To evaluate how the law has been implemented, researchers collected publicly available policies and additional information provided directly by county jails between June and October 2024.

Among the 28 jails that provided policy information, researchers found:

• • 71% described screening individuals for substance use disorder.
  • 67% outlined policies for providing medications for opioid use disorder.
  • 63% described connecting people with treatment after release.
  • 46% indicated they offered all three FDA-approved medications for opioid use disorder.
  • 26% included peer recovery support services.
  • 22% described harm-reduction services such as providing naloxone upon release.

The researchers also found notable differences between urban and rural counties. Urban jails were generally more likely to have comprehensive policies for screening, treatment and post-release care, while rural jails often faced limited access to opioid treatment programs and other community resources.

"Some jails want to offer these medications but face significant barriers," she said. "Methadone, for example, must be dispensed through federally regulated and state-licensed opioid treatment programs, which can make access especially difficult in rural areas. Sustainable funding, technical assistance and partnerships with community providers will be essential to fully implement the law."

Without medication, people experiencing opioid withdrawal while incarcerated can suffer severe physical symptoms and intense cravings, increasing their risk of returning to opioid use after release.

"When these medications aren't available, people may go through painful withdrawal while they're in custody," LeMasters said. "After release, that can increase the risk of returning to opioid use, overdose and death."

The researchers emphasize that the study evaluated written policies rather than actual clinical practice, meaning some jails may provide services that are not reflected in publicly available documents. Still, they say transparency is essential for ensuring continuity of care and identifying where additional resources are needed.

As more states consider requiring medications for opioid use disorder in correctional settings, the researchers say Colorado's experience offers important lessons about the challenges of translating legislation into consistent statewide practice.

"This is ultimately about saving lives," LeMasters said. "Jails are an important place to reach people with opioid use disorder, but they shouldn't be the only place. Expanding access to treatment in communities before people enter the criminal justice system remains just as important."

LeMasters co-authored the study with Paul Christine, MD, PhD, assistant professor of medicine at CU Anschutz; Jarratt Pytell, MD, assistant professor of medicine at CU Anschutz; Alena Gabrielson and Selena Munoz-Jones, PhD students at CU Boulder; Betsy Craft, a Peer Support Specialist and harm reductionist; Hayley Rotello, a social work supervisor at Denver Health; and Ingrid Binswanger, MD, professor of medicine at CU Anschutz and senior clinical investigator at Kaiser Permanente.

Key Points

• Nearly 40% of Colorado county jails did not have publicly available policies for medications for opioid use disorder (MOUD), despite a 2022 state law requiring them.
• Fewer than half of jails with available policies indicated they offered all three FDA-approved medications for opioid use disorder.
• Urban jails were more likely than rural jails to have comprehensive policies for screening, treatment and post-release care.
• Researchers say greater transparency, sustainable funding and stronger community partnerships are needed to ensure consistent implementation of evidence-based opioid treatment in county jails.
• The findings highlight that legislation alone is not enough to guarantee equitable access to lifesaving care for incarcerated people with opioid use disorder.