Chapin Hall

Improving Opioid Addiction Treatment for People Who Are Incarcerated

At the height of the COVID-19 pandemic, in a community with high rates of opioid addiction, a jail in rural Greenfield, Massachusetts showed that treating addiction for people cycling in and out of incarceration can be done better. The jail houses between 150 and 200 individuals, approximately half of whom have an opioid use disorder diagnosis. In 2020, the Franklin County Sheriff’s Office (FCSO) capitalized on its previously built infrastructure and system partners to offer all three federally approved medications for opioid use disorders—buprenorphine, methadone, and naltrexone. It also began to remotely provide therapeutic counseling to incarcerated people as a critical component of treatment. FCSO was able to continue offering all three medications during the pandemic and meet the diverse clinical needs of people coming into their jail. Importantly, FCSO also set out to deliver high–quality counseling via telehealth. Accessible and effective counseling can address the complexities of mental health needs and make carceral environments more rehabilitative. 

What We Did

From 2020 to 2023, a team of researchers from Chapin Hall at the University of Chicago and Urban Institute partnered with FCSO to conduct a mixed-methods evaluation that examined how their jail approached Medication for Opioid Use (MOUD) treatment, particularly via telehealth during the COVID-19 pandemic. Our goal was to understand whether treatment and individual counseling could be done remotely. We also wanted to understand why individual counseling was or was not successful and how clients (incarcerated people) and the professionals supporting them perceived the effects.

What We Found

• Over a decade ago, FCSO leadership set a vision and a strategy to become a nationally recognized facility that prioritizes high-quality behavioral health treatment rather than simply “warehousing” people. Such transformation took time, but our findings suggest that at the start of the COVID-19 pandemic, most FCSO staff recognized their important role in curbing high rates of opioid addiction in Franklin County. Staff made significant strides in expanding behavioral health treatment and therapeutic counseling.
• By 2020, FCSO was offering all three modalities of federally approved medications to treat opioid use disorders as continuation and induction options. While most jails in the United States still do not offer any medications for opioid use disorders, FCSO provided a range of options to meet the complex needs of people with opioid use disorder diagnoses wherever they are in the recovery stage.
• Our evaluation demonstrates ways FCSO was able to provide high-quality one-on-one counseling remotely at the height of the COVID-19 pandemic. For example, out of 31 surveyed clients, 90% reported a strong bond with their counselor, also known as therapeutic alliance, and 87% of respondents said that counseling via telehealth helped them more effectively deal with problems in their lives, including addiction.
• Some FCSO behavioral health staff reported challenges doing trauma work in jail with people struggling with addiction who often get released quickly. But, overall, staff praised FCSO’s decision to offer high-quality counseling and maximize client time in therapy to address important mental health needs.

What It Means

That so many clients report a strong therapeutic bond with their counselor is a positive finding, whether among the general population or in a specialized facility. Our hope is that FCSO’s example inspires other jails and correctional facilities across the country to rely on individual counseling more often to address mental health needs of people with opioid use disorders. Establishing a treatment-oriented philosophy and changing institutional culture takes time. Ultimately, FCSO has offered all three medications and provided high-quality counseling that promotes clients’ well-being and success.

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