Local Solutions to Medications for Opioid Use Disorder Care for Patients in Rural Jails

Abstract

Providing medications for opioid use disorder (MOUD) in correctional settings is a critical tool for addressing opioid overdose. However, access to MOUD remains limited in rural county jails. This article describes a simple, community-based initiative where a rural community primary care clinic partnered with a county jail to provide MOUD care via telemedicine. This initiative was a local response to expanding jail-based MOUD after the jail’s contracted health provider declined to offer these services. Between 2022 and mid-2024, 31 incarcerated patients received MOUD, representing approximately 10% of the clinic’s total MOUD patients. More than half (58%) had received MOUD in the past, whereas 42% of patients were new to MOUD. Nearly a third of patients either maintained or established relationships with the clinic for postrelease care. Implementation involved a brief planning period and iterative plan-do-study-act cycles to address logistical challenges, including dosing frequency, referral processes, and diversion concerns. The initiative relied on State Opioid Response grants for funding and preexisting community partnerships fostered by a countywide overdose prevention initiative. This local, community-driven model highlights the potential for expanding MOUD access in small, rural jails. It emphasizes the value of flexible telemedicine delivery and strong collaboration between clinics and jail staff.