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Hamilton County, OH Advances Treatment for Opioid Use Disorder in Jail

Updated: May 18

In Hamilton County, Ohio, 76% of the people who overdosed in 2021 had a history of incarceration at the Hamilton County Justice Center (HCJC), the county jail. In response to this, the HCJC launched a medication for opioid use disorder (MOUD) program, with input from the HCS Intervention Design Team, technical experts, and input from other jurisdictions with MOUD programs, including Kenton County, KY jail and Cuyahoga County, OH jail.

Research shows that starting medications for opioid use disorder (MOUD) prior to release and continuing them during reentry reduces the risk of overdose death by 75%. The HCJC model includes induction of MOUD for individuals with an opioid use disorder (OUD) and utilization of peer recovery supporters and licensed chemical dependency counselors to assist individuals upon release. The key community partners in operationalizing the MOUD programs were Sheriff Charmaine McGuffey, NaphCare, Addiction Services Council, Hamilton County Mental Health & Recovery Services Board, and Talbert House.

A comprehensive MOUD approach

Using a chronic-care approach, HCJC’s MOUD program provides incarcerated individuals with OUD with an opportunity to begin MOUD treatment during their incarceration or to continue their medications if previously inducted in the community. When an individual enters the HCJC, they are screened for treatment eligibility and substance use. Staff in the MOUD program are members of the internal addiction response team, a MOUD nurse, the Sheriff’s Command Staff, an Addiction Services Coordinator, pretrial service staff, and a peer mentor. “The Sheriff and key leadership across the county came together to provide the best evidence-based interventions to one of our most at-risk populations — incarcerated individuals with substance use disorders” stated Tina Ernst, Intervention Facilitator for HEALing Communities.

When it is time for participants to be released, HCJC pairs them with peer recovery supporters  who help with connections to community treatment providers, transportation, and support. The recovery supporters arrive as early as 4 a.m. to drive participants to their first appointments and provide support to the individuals returning throughout their transition back into the community.

HCJC has built relationships with over 40 treatment agencies providing individualized care in the community, including intensive outpatient programs, outpatient MOUD, residential treatment programs, and recovery housing programs. HCJC staff and peer recovery supporters  directly link participants to the appropriate community provider to ensure continuity of care.

The Hamilton County program is evidence that by embedding treatment and recovery options into criminal legal settings, communities can effectively target their programming to high-risk individuals as they pass through the system. Hamilton County reported a 16% reduction in overdose deaths in 2022, the first decrease in overdose deaths in four years.

HCJC is part of the HEALing Communities Study, (HCS), a multi-site research study, tested the impact of an integrated set of evidence-based practices across healthcare, behavioral health, justice, and other community-based settings. HEALing Communities is funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative®.

HEAL Connections

Research results need to benefit people living with pain, addiction, and other co-occurring conditions but too often get stuck in journal articles and conference presentations. The HEAL Connections Center through funding from the NIH HEAL Initiative® under OTAs 1OT20D034479 and 1OT2OD034481, aims to translate HEAL research into action. Learn more here.


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