Background & Introduction: Opioid use disorder (OUD) is highly prevalent among incarcerated populations, 2024 estimates in the Pittsburgh Pennsylvania area suggest that about 30% of incarcerated individuals have OUD, and more than half have any substance use disorder (SUD),1 yet access to evidence-based treatment remains limited in many correctional facilities. Nationwide, fewer than half of jails offer any form of medication for opioid use disorder (MOUD) and only an estimated 13% of jails provide MOUD to anyone who requests it.2,3 Formerly incarcerated individuals are more than 10x as likely to die from an opioid overdose compared to the general population, with the greatest risk in the first two weeks after release.4 Methadone maintenance therapy (MMT) is one of the gold standards for treatment of OUD, because it reduces withdrawal symptoms, cravings, and risk of relapse. Integrating MMT into jail settings improves health outcomes and reduces recidivism.5
Case Description: On November 30, 2023, ACJ reached a settlement agreement with the US Department of Justice (DOJ) in which ACJ committed to providing all MOUD services (including MMT initiation) to all persons who meet clinical eligibility criteria and are incarcerated there for at least 72 hours.6 In November of 2024, an outpatient treatment program (OTP), or “methadone clinic”, was established within ACJ to provide continuity of care for individuals with OUD and start patients on methadone if they requested it. In March 2025, the OTP received approval from the DOJ, Drug Enforcement Agency (DEA), and the Substance Abuse and Mental Health Services Administration (SAMHSA) to initiate MMT for patients at ACJ. Eligible participants were identified through screening at intake or by self-referral. Methadone dosing was initiated or continued under medical supervision, with regular monitoring for efficacy and safety.
In January 2025, the Allegheny County Department of Human Services (DHS) published an extensive, publicly available dashboard describing the ACJ’s MOUD program performance.7 Data is continuously updated on treatment retention, adverse events, and post-release linkage to community-based care. The primary data source for this dashboard is the ACJ electronic health records. This dataset includes information on patients receiving MOUD, the specific medications prescribed, the dates of these prescriptions, and their jail booking date.
Of the approximately 1,800 individuals served in 2024, 46% received MOUD services within two days after intake and 83% were served within one week. 55% of MOUD patients were connected to community-based services within 3 days after release, supporting ongoing recovery and reducing risk of overdose. The median length of jail stay among program patients is 38 days. Currently, there are 464 individuals in ACJ who receive MOUD, 22% of the total current ACJ population.
Since mid-March 2025 and as of mid-October 2025, the OTP has completed 338 patient methadone inductions, and have an average of 117 patients monthly receiving MMT (including 37 patients monthly who are “guest dosing”, individuals who were established with a community OTP prior to booking and are continuing their MMT at ACJ). In addition, ACJ has an alternative housing program in which patients live in a less restrictive recovery setting and continue their MMT with a partner community OTP in Pittsburgh; there are currently 25 patients in this program.
Conclusion & Discussion: The implementation of an OTP within a jail setting is feasible and effective, supporting continuity of care for individuals with OUD. This model can reduce opioid-related morbidity and mortality, facilitate successful reentry into the community, contribute to lower rates of recidivism, and improve health equity. With the use of opioid settlement funds, Allegheny County has demonstrated what is possible, and offers a practical blueprint for other communities who wish to expand MOUD implementation in their local jails. ACJ is leading the way to prove MMT is possible and successful.
References: 1. The Allegheny County Department of Human Services (2025, August). From Barriers to Breakthroughs: Delivering Lifesaving Opioid Use Disorder Treatment to People in the Allegheny County Jail. [Press release]. https://analytics.alleghenycounty.us/wp-content/uploads/2025/08/MOUD-in-jail-narrative-report-08-2025_ACDHS.pdf
2. National Institute on Drug Abuse. (2024, September 24). Fewer than half of U.S. jails provide life saving medications for opioid use disorder [Press release]. https://nida.nih.gov/news-events/news-releases/2024/09/fewer-than-half-of-us-jails-provide-life-saving-medications-for-opioid-use-disorder
3. Flanagan Balawajder, E., Ducharme, L., Taylor, B. G., Lamuda, P. A., Kolak, M., Friedmann, P. D., Pollack, H. A., & Schneider, J. A. (2024). Factors associated with the availability of medications for opioid use disorder in US jails. JAMA Network Open, 7(9). https://doi.org/10.1001/jamanetworkopen.2024.34704
4. Hartung, D. M., McCracken, C. M., Nguyen, T., Kempany, K., & Waddell, E. N. (2023). Fatal and nonfatal opioid overdose risk following release from prison: A retrospective cohort study using linked Administrative Data. Journal of Substance Use and Addiction Treatment, 147, 208971. https://doi.org/10.1016/j.josat.2023.208971
5. Berk, J., South, A.-M., Martin, M., James, M.-E., Miller, C., Haber, L., & Rich, J. (2025). Medication for opioid use disorder service delivery in carceral facilities: Update and summary report. Health & Justice, 13(8). https://doi.org/10.1186/s40352-025-00317-9
6. US Department of Justice. (2023, November 30). Justice Department secures agreement from Pennsylvania jail to provide medications for opioid use disorder [Press release]. https://www.justice.gov/archives/opa/pr/justice-department-secures-agreement-pennsylvania-jail-provide-medications-opioid-use
7. Allegheny County Department of Human Services. Medication for Opioid Use Disorder (MOUD) in the Allegheny County Jail (ACJ). https://tableau.alleghenycounty.us/t/PublicSite/views/MedicationforOpioidUseDisorderMOUDinACJ/HomePage?%3AshowAppBanner=false&%3Adisplay_count=n&%3AshowVizHome=n&%3Aorigin=viz_share_link%3Aembed&%3AisGuestRedirectFromVizportal=y#1
Disclosure(s):
James Y. Lim, MD: No disclosure to display
Learning Objectives:
Describe why OUD is a major challenge in the carceral setting and the ways a methadone program can improve patient care
Describe how the methadone program at Allegheny County Jail came into existence
Describe the impact the methadone program has had on the patient population at Allegheny County Jail
