Evidence
Evidence and References for Medically Assessed Treatment for the El Paso County Jail-Based Behavioral System (JBBS).
Peer-reviewed research
1. Friedmann, P. D., Wilson, D., Stopka, T. J., Bernson, D., Pivovarova, E., Ferguson, W., Hoskinson, R. A., Jr., Rottapel, R. E., Bovell-Ammon, B., Gaba, A., Morgan, J. R., Senst, T., Hayes, E., & Evans, E. A. (2025). Medications for opioid use disorder in county jails—Outcomes after release. New England Journal of Medicine, 393(10), 994–1003. DOI: 10.1056/NEJMsa2415987.
NEJM article: Click Here
1a. Why this is one of our strongest references: This large study included 6,400 people with probable OUD in Massachusetts county jails. Jail MOUD was associated with lower risks of fatal overdose, nonfatal overdose, all-cause death, and reincarceration after release.
2. Lim, S., Cherian, T., Katyal, M., Goldfeld, K. S., McDonald, R., Wiewel, E., et al. (2023). Association between jail-based methadone or buprenorphine treatment for opioid use disorder and overdose mortality after release from New York City jails, 2011–17. Addiction, 118(3), 459–467. DOI: 10.1111/add.16071.
Addiction article: Click Here
This is especially useful for life-saving assertions: among 15,797 adults with OUD, receiving methadone or buprenorphine in jail was associated with an 80% lower overdose-mortality risk during the first month after release.
3. Moore, K. E., Roberts, W., Reid, H. H., Smith, K. M. Z., Oberleitner, L. M. S., & McKee, S. A. (2019). Effectiveness of medication-assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review. Journal of Substance Abuse Treatment, 99, 32–43. DOI: 10.1016/j.jsat.2018.12.003.
PubMed record: Click Here
This is an excellent source when challenged on whether MAT actually works in corrections. The meta-analysis found correctional methadone treatment increased community treatment engagement and reduced illicit opioid and injection-drug use.
4. Malta, M., Varatharajan, T., Russell, C., Pang, M., Bonato, S., & Fischer, B. (2019). Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review. PLOS Medicine, 16(12), e1003002. DOI: 10.1371/journal.pmed.1003002.
PLOS Medicine article: Click Here
This systematic review examined 46 studies and found correctional opioid-agonist treatment was associated with improved treatment adherence, less relapse, and—when linked to post-release care—reductions in overdose and mortality.
5. Cates, L., & Brown, A. R. (2023). Medications for opioid use disorder during incarceration and post-release outcomes. Health & Justice, 11, 4. DOI: 10.1186/s40352-023-00209-w.
Health & Justice article: Click Here
The review found that MOUD during incarceration generally increased post-release treatment engagement and was associated with decreased opioid use and overdose without evidence of increased criminal involvement.
6. Evans, E. A., et al. (2022). Recidivism and mortality after in-jail buprenorphine treatment for opioid use disorder. Drug and Alcohol Dependence.
PubMed record: Click Here
In the Massachusetts natural experiment, people with an opportunity to receive jail-based buprenorphine had significantly lower post-release recidivism than the comparison group.
7. Magura, S., Lee, J. D., Hershberger, J., Joseph, H., Marsch, L., Shropshire, C., & Rosenblum, A. (2009). Buprenorphine and methadone maintenance in jail and post-release: A randomized clinical trial. Drug and Alcohol Dependence. DOI: 10.1016/j.drugalcdep.2008.08.006.
PubMed record: Click Here
8. Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison—A high risk of death for former inmates. New England Journal of Medicine, 356(2), 157–165. DOI: 10.1056/NEJMsa064115.
PubMed record: Click Here
This landmark study is particularly valuable for explaining why the transition out of custody matters. Mortality was sharply elevated during the first two weeks after release, with drug overdose being a major driver.
9. Hartung, D. M., McCracken, C. M., Nguyen, T., Kempany, K., & Waddell, E. N. (2023). Fatal and non-fatal opioid overdose risk following release from prison: A retrospective cohort study using linked administrative data. Journal of Substance Use and Addiction Treatment, 147, 208971. DOI: 10.1016/j.josat.2023.208971.
CDC-hosted article record: Click Here
10. Extended-release buprenorphine systematic review (2024). Feasibility and effectiveness of extended-release buprenorphine (XR-BUP) among correctional populations: A systematic review. DOI: 10.1080/00952990.2024.2360984.
Full systematic review: Click Here
This supports the discussion we added about long-acting injectable buprenorphine/Sublocade around release. Ten studies involving 819 participants were included, although the authors appropriately describe the evidence base as still developing.
Federal clinical and correctional guidance
11. Substance Abuse and Mental Health Services Administration. (2021, updated resource). TIP 63: Medications for Opioid Use Disorder. SAMHSA.
SAMHSA TIP 63: Click Here
This should be one of the primary clinical references in the packet. It covers methadone, buprenorphine, and naltrexone; withdrawal; treatment initiation; and justice-involved populations. SAMHSA specifically identifies the elevated overdose risk following release when OUD medication is interrupted.
12. Substance Abuse and Mental Health Services Administration (June 2025). Guidelines for Implementing Medications for Opioid Use Disorder Treatment in State Prisons. SAMHSA criminal-justice MAT Guidelines: Click Here
This source discusses correctional programs using buprenorphine, methadone, and naltrexone and describes comprehensive access to MAT/MOUD as a correctional best-practice approach.
13. Centers for Disease Control and Prevention. (2025). Linking people with opioid use disorder to medication treatment.
CDC clinical guidance: Click Here
The CDC recommends uninterrupted MOUD for people already receiving treatment, initiation in criminal-justice settings when appropriate, access to FDA-approved options, and a warm handoff to community treatment following release.
14. Bureau of Justice Assistance & National Institute of Corrections. (2023). Guidelines for Managing Substance Withdrawal in Jails: A Tool for Local Government Officials, Jail Administrators, Correctional Officers, and Health Care Professionals. U.S. Department of Justice.
BJA withdrawal guidelines: Click Here
For your audience, this is especially strong because it is corrections-specific federal guidance, not simply a community addiction-treatment guideline.
15. Federal Bureau of Prisons. (2021). Opioid Use Disorder: Diagnosis, Evaluation, and Treatment—Clinical Guidance.
Federal Bureau of Prisons clinical guidance: Click Here
This is the source behind the opioid-withdrawal timeline used in our MAT graphic:
- Short-acting opioids: symptoms generally begin 8–24 hours, become fully developed at 1–3 days, and typically last 7–10 days.
- Long-acting opioids: onset can take up to 36 hours, fully developed withdrawal around 72–96 hours, and total withdrawal may last 14 days or longer.
16. National Commission on Correctional Health Care. (2025). Jail Guidelines for the Medical Treatment of Substance Use Disorders.
NCCHC Jail-Based MAT resources: Click Here
This is particularly useful with a law-enforcement panel because the current guidance is endorsed by correctional-health and jail organizations and focuses specifically on implementing treatment safely inside jails.
17. National Sheriffs’ Association & National Commission on Correctional Health Care. (2018). Jail-Based Medication-Assisted Treatment: Promising Practices, Guidelines, and Resources for the Field.
National Sheriffs’ Association MAT guidance: Click Here
This may be one of the most strategically relevant sources for your panel because MAT guidance is coming from the National Sheriffs’ Association itself, in collaboration with NCCHC.
18. American Society of Addiction Medicine. (2025). Public Policy Statement on Treatment of Opioid Use Disorder in Correctional Settings.
ASAM correctional OUD statement: Click Here
ASAM identifies methadone, buprenorphine, and extended-release naltrexone as medications used for OUD and supports access to evidence-based MOUD in correctional institutions.
Medication / Sublocade references
19. U.S. Food and Drug Administration. (2025). SUBLOCADE (buprenorphine extended-release) injection: Prescribing information.
FDA Sublocade prescribing information: Click Here
This is the authoritative source for the Sublocade section in MAT Version 1.2/1.3. The FDA label identifies Sublocade as extended-release buprenorphine for moderate-to-severe OUD and provides the approved initiation and monthly-maintenance dosing framework.
20. U.S. Food and Drug Administration. Information about Medications for Opioid Use Disorder (MOUD).
FDA MOUD information: Click Here
Useful for documenting the FDA-approved medication categories and formulations, including buprenorphine products such as Sublocade and Brixadi as well as methadone and naltrexone.
El Paso County primary sources
These references support the local facts in your presentation.
21. El Paso County Sheriff’s Office. Jail Based Behavioral Health (JBBS).
EPSO Jail Based Behavioral Health: Click Here
EPSO states that JBBS provides substance-use counseling, MAT education/referrals, release planning, behavioral-health counseling, community referrals, and connection of people at high overdose risk to MAT.
22. El Paso County Sheriff’s Office. Detention Bureau. PAGE NOT FOUND
EPSO Detention Bureau
23. El Paso County Sheriff’s Office. (2025). Sheriff’s Office Discusses Mental Health and Jail Population at a City Council Working Session.
EPSO behavioral-health presentation and statistics: Click Here
This is our strongest source for the statement that the overall average length of stay is 32 days, that more than half of the jail population is sentenced on or facing felony charges, and that the approximate daily jail population exceeds 1,600. This is the critical source for our 2024 numbers:
480 substance-disorder group meetings; 3,037 participants; 3,047 comprehensive treatment plans prepared upon release; and 808 incarcerated individuals receiving Narcan upon release. It also reports that 60% of the incarcerated population reports a mental-health concern and 37% receives psychotropic medication treatment.
It is also the source for Sheriff Joseph Roybal’s statement that incarcerated people leave the jail “healthier and with more resources” than when they entered.
24. El Paso County Sheriff’s Office. 2024 Annual Report.
EPSO 2024 Annual Report information: Click Here
25. El Paso County Sheriff’s Office. 2023 Strategic Plan / JBBS performance information. The report documents substantial JBBS release-planning activity and continued collaboration with Intake and Release.
EPSO strategic-plan document: Click Here
26. El Paso County. (2024). Region 16 Opioid Council—Medication Assisted Treatment/Medication for Opioid Use Disorder appropriation. The county appropriated $321,800 from Region 16 Opioid Council funding for MAT/MOUD to the Sheriff’s Office 2024 budget.
El Paso County MAT/MOUD appropriation: Click Here
Colorado JBBS references
27. Colorado Behavioral Health Administration / Colorado General Assembly. Jail-Based Behavioral Health Services. State budget documentation reports that in FY 2023–24, JBBS served 42,296 individuals across 48 jails, including 15,763 individuals receiving MAT.
Colorado General Assembly JBBS documentation: Click Here
This is one of the strongest statistics for demonstrating that MAT is not an isolated El Paso County experiment—it is part of a statewide correctional behavioral-health system.
28. Colorado General Assembly. (2024). Treatment of Persons with Behavioral Health Disorders in the Criminal and Juvenile Justice System Final Report.
Colorado General Assembly report: Click Here
29. Colorado General Assembly / Joint Budget Committee. Jail-Based Behavioral Health Services budget documentation. Colorado describes JBBS as supporting behavioral-health services during incarceration and continuity of care following release.
Click Here
30. El Paso County / Colorado Behavioral Health Administration. (FY 2025–26). JBBS Exhibit B-5 Budget and Rate Schedule.
El Paso County JBBS budget document: Click Here
31. El Paso County Board of County Commissioners. (2026). Resolution recognizing $1.6 million from the Colorado Department of Human Services, Behavioral Health Administration for jail-based behavioral services in the Sheriff’s Office 2026 budget.
El Paso County $1.6M JBBS funding record: Click Here
That date distinction matters: $1.6 million is a 2026 budget figure, so we should not describe it as 2024 JBBS funding.
Incarcerated-population prevalence
32. Bronson, J., Stroop, J., Zimmer, S., & Berzofsky, M. (2017). Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007–2009. Bureau of Justice Statistics, U.S. Department of Justice. NCJ 250546.
Bureau of Justice Statistics report: Click Here
The frequently used 63% figure comes from this older national dataset: approximately 63.3% of sentenced jail inmates met DSM-IV criteria for drug dependence or abuse. It is useful background, but it should not be presented as a current El Paso County statistic.
33. National Institute on Drug Abuse. Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide.
NIDA criminal-justice treatment guide: Click Here
Potency of Opioids
- Comer, S. D., & Cahill, C. M. (2019). Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neuroscience & Biobehavioral Reviews, 106, 49–57.
This is probably the best peer-reviewed source for the potency section. It discusses fentanyl pharmacology, rapid CNS penetration, respiratory depression, and why potency estimates depend upon route of administration. It notes the commonly accepted clinical comparison of approximately 100× morphine, while documenting considerable variation by route.
Full article through PubMed Central: Click Here - Stanley, T. H. (2014). The fentanyl story. The Journal of Pain, 15(12), 1215–1226.
This is an excellent historical/pharmacological reference for explaining the development of fentanyl and the transition toward extremely potent synthetic opioids. Click here - Vardanyan, R. S., & Hruby, V. J. (2014). Fentanyl-related compounds and derivatives: Current status and future prospects for pharmaceutical applications. Future Medicinal Chemistry, 6(4), 385–412.
This peer-reviewed pharmacology review describes fentanyl as approximately 50–100× more potent than morphine and discusses respiratory depression and the pharmacology of fentanyl derivatives. Importantly, it also states that a human fentanyl LD50 is unknown—supporting our decision not to present a universal lethal dose as a scientific certainty.
Full article through PubMed Central: Click Here - Reichle, C. W., Smith, G. M., Gravenstein, J. S., Macris, S. G., & Beecher, H. K. (1962). Comparative analgesic potency of heroin and morphine in postoperative patients. Journal of Pharmacology and Experimental Therapeutics, 136(1), 43–46.
This classic controlled human study found heroin approximately 2–4× as potent as morphine for postoperative analgesia, while emphasizing that there is no single universally applicable equianalgesic ratio. That makes it an excellent source for qualifying the ~2–3× heroin figure in Potency 1.2. No accessible link - O’Donnell, J., Tanz, L. J., Miller, K. D., et al. (2023). Drug overdose deaths with evidence of counterfeit pill use—United States, July 2019–December 2021. Morbidity and Mortality Weekly Report, 72(35), 949–956.
This is particularly valuable for your blue M30 image. CDC documents counterfeit pills designed to resemble prescription oxycodone and specifically identifies M30-marked counterfeit oxycodone pills in overdose investigations. Counterfeit-pill evidence in overdose deaths increased substantially during the study period.
CDC MMWR article: Click Here - Glidden, E., Gladden, R. M., Dion, C., Spyres, M. B., Seth, P., Aldy, K., Mustaquim, D., et al. (2024). Suspected counterfeit M-30 oxycodone pill exposures and acute withdrawals reported from a single hospital—Toxicology Investigators Consortium Core Registry, U.S. Census Bureau Western Region, 2017–2022. MMWR, 73(29), 642–647.
This is an especially strong recent reference because it specifically examines counterfeit M30 pills containing illicit fentanyl. CDC reports that these exposures increased sharply and notes the DEA benchmark of ≥2 mg fentanyl as a potentially lethal amount in its discussion of seized counterfeit pills.
CDC MMWR study Click Here - Moore, K. E., Roberts, W., Reid, H. H., Smith, K. M. Z., Oberleitner, L. M. S., & McKee, S. A. (2019). Effectiveness of medication assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review. Journal of Substance Abuse Treatment, 99, 32–43.
This is highly relevant to your “Implications for MAT in Jails” panel because it synthesizes research on medications for OUD in correctional populations. Click Here - Medications for opioid use disorder during incarceration and post-release outcomes (2023). Health & Justice.
This peer-reviewed review examined 29 articles representing 22 studies. It found substantial evidence that providing MOUD during incarceration improves post-release treatment engagement, with evidence of reductions in opioid use and overdose and no evidence that providing medication increases criminal involvement.
Peer-reviewed Health & Justice article. Click Here - National Academies of Sciences, Engineering, and Medicine. (2019). Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press.
This is one of the strongest consensus reports available for defending methadone, buprenorphine, and extended-release naltrexone as evidence-based treatments for OUD. Click Here - Substance Abuse and Mental Health Services Administration. Treatment Improvement Protocol 63: Medications for Opioid Use Disorder.
This is a major clinical reference supporting methadone, buprenorphine, and naltrexone and provides an authoritative foundation for describing MAT/MOUD as medical treatment rather than a reward or substitution of one addiction for another. Click Here
Recovery Process
1. Kelly, J. F., Bergman, B. G., Hoeppner, B. B., Vilsaint, C. L., & White, W. L. (2017). Prevalence and pathways of recovery from drug and alcohol problems in the United States population: Implications for practice, research, and policy. Drug and Alcohol Dependence, 181, 162–169. doi:10.1016/j.drugalcdep.2017.09.028.
Supports: The graphic’s 9.1% estimate of U.S. adults who had resolved a significant alcohol or drug problem and the 53.9% who reported using an assisted recovery pathway.
PubMed record: Click Here
2. Hoffman, L. A., Vilsaint, C., & Kelly, J. F. (2020). Recovery from opioid problems in the U.S. population: Prevalence, pathways, and psychological well-being. Journal of Addiction Medicine, 14(3), 207–216. doi:10.1097/ADM.0000000000000561.
Supports: Approximately 1.18 million U.S. adults, or 0.48% of the adult population, had resolved a primary opioid problem. It also provides an especially useful academic framework for early versus longer-term opioid recovery.
Full article via NIH/PMC: Click Here
3. Magura, S., Lee, J. D., Hershberger, J., Joseph, H., Marsch, L., Shropshire, C., & Rosenblum, A. (2009). Buprenorphine and methadone maintenance in jail and post-release: A randomized clinical trial. Drug and Alcohol Dependence, 99(1–3), 222–230. doi:10.1016/j.drugalcdep.2008.08.006.
Supports: In the Rikers Island randomized trial, 48% of participants assigned to buprenorphine reported to their designated community treatment after release compared with 14% assigned to methadone.
PubMed record: Click Here
4. Kinlock, T. W., Gordon, M. S., Schwartz, R. P., Fitzgerald, T. T., & O’Grady, K. E. (2009). A randomized clinical trial of methadone maintenance for prisoners: Results at 12 months post-release. Journal of Substance Abuse Treatment, 37(3), 277–285. doi:10.1016/j.jsat.2009.03.002.
Supports: The graphic’s argument for initiating MAT during incarceration rather than waiting until release and the improved community-treatment engagement associated with prison-initiated methadone.
PubMed record: Click Here
5. Green, T. C., Clarke, J., Brinkley-Rubinstein, L., et al. (2018). Postincarceration fatal overdoses after implementing medications for addiction treatment in a statewide correctional system. JAMA Psychiatry, 75(4), 405–407. doi:10.1001/jamapsychiatry.2017.4614.
Supports: Rhode Island’s comprehensive correctional MAT program was associated with a 60.5% reduction in post-incarceration overdose mortality among recently incarcerated individuals, from 26 deaths to 9.
JAMA Psychiatry article: Click Here May not be viewable without access.
6. Fazel, S., Yoon, I. A., & Hayes, A. J. (2017). Substance use disorders in prisoners: An updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction, 112(10), 1725–1739. doi:10.1111/add.13877.
Supports: The broader correctional need argument. Across 24 studies involving 18,388 prisoners, pooled drug-use-disorder prevalence was approximately 30% among men and 51% among women, while alcohol-use-disorder prevalence was approximately 24%.
PubMed record: Click Here
Mental Illness 1.5
- Barry, R., Anderson, J., Tran, L., et al. (2024). Prevalence of mental health disorders among individuals experiencing homelessness: A systematic review and meta-analysis. JAMA Psychiatry, 81(7), 691–699.
Read Study — JAMA Psychiatry: Click Here - Maruschak, L. M., Bronson, J., & Alper, M. (2021). Indicators of mental health problems reported by prisoners: Survey of Prison Inmates, 2016. Bureau of Justice Statistics.
Read Report — Bureau of Justice Statistics: Click Here - Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health.
Read National Report — SAMHSA: Click Here
Correctional Recovery Continuum 1.5
- National Institute on Drug Abuse. (2014). Principles of drug abuse treatment for criminal justice populations: A research-based guide. National Institutes of Health. Click here
- Bureau of Justice Assistance. (2023). Guidelines for managing substance withdrawal in jails. U.S. Department of Justice.
Read Guidelines — Bureau of Justice Assistance: Click Here - Lee, E. B., An, W., Levin, M. E., & Twohig, M. P. (2015). An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders. Drug and Alcohol Dependence, 155, 1–7.
Read Study — PubMed: Click Here - Bolívar, H. A., Klemperer, E. M., Coleman, S. R. M., DeSarno, M., Skelly, J. M., & Higgins, S. T. (2021). Contingency management for patients receiving medication for opioid use disorder: A systematic review and meta-analysis. JAMA Psychiatry, 78(10), 1092–1102.
Read Full Study — PubMed Central: Click Here - Landenberger, N. A., & Lipsey, M. W. (2005). The positive effects of cognitive-behavioral programs for offenders: A meta-analysis of factors associated with effective treatment. Journal of Experimental Criminology, 1, 451–476.
Read Study — Springer Nature: Click Here - Substance Abuse and Mental Health Services Administration. (2021). Medications for opioid use disorder. Treatment Improvement Protocol (TIP) Series 63.
Read TIP 63 — SAMHSA: Click Here - Weimer, M. B., Herring, A. A., Kawasaki, S. S., Meyer, M., Kleykamp, B. A., & Ramsey, K. S. (2023). ASAM clinical considerations: Buprenorphine treatment of opioid use disorder for individuals using high-potency synthetic opioids. Journal of Addiction Medicine, 17(6), 632–639.
Read Study — PubMed: Click Here - National Commission on Correctional Health Care. (2026). Opioid use disorder treatment in correctional settings.
Read Correctional Treatment Guidelines — NCCHC: Click Here
Anxiety
“Exercise is the most transformative thing . . .!!”
References
1. Using exercise to increase Self-efficacy and Improve Health Behaviors,
https://research.wsulibs.wsu.edu/xmlui/bitstream/handle/2376/4016/J_Fletcher_010202495.pdf?sequence=1
2. Capitalizing upon the Physical: Exercise and Addiction Recovery
https://etheses.whiterose.ac.uk/19316/
3 The Potential Role of Physical Exercise in Addiction Treatment and Recovery: The Social Cost of Substance Misuse.
https://www.researchgate.net/profile/Tom-Peric/publication/244988236_The_potential_role_of_physical_exercise_in_addiction_treatment_and_recovery_the_social_costs_of_substance_misuse/links/5c29343f458515a4c7029a72/The-potential-role-of-physical-exercise-in-addiction-treatment-and-recovery-the-social-costs-of-substance-misuse.pdf
4. The relationship between Self-control and Self-Efficacy Among Patients with Substance Use Disorder: Resilience and Self-Esteem as Mediators.
https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00388/full
5. Rat park study
https://en.wikipedia.org/wiki/Rat_Park
6. Different Types of Exercises Affect Different Parts of Your Brain
https://www.linkedin.com/pulse/different-types-exercises-affect-parts-your-brain-loredana-trandu
7. Can you re-train your brain?
https://pronghornpsych.com/can-you-retrain-a-brain-with-anxiety/
8.Hypothalamus, hypertension, and exercise