Albizu-Garcia, C. E., Caraballo, J. N., Caraballo-Correa, G., Hernandez-Viver, A., & Roman-Badenas, L. (2012). Assessing need for medication-assisted treatment for opiate-dependent prison inmates. Subst Abus, 33(1), 60-69. doi:10.1080/08897077.2011.620462
This article provides information on the pilot MAT program implemented in The Department of Correction and Rehabilitation (DCR) of Puerto Rico (PR), a US territory. It reports on the research process, the needs assessment conducted, the findings and recommendations to expand MAT for eligible inmates, and lessons learned. This article serves to help provide insight into one system’s efforts to guide planning for an expansion of drug treatment services in correctional facilities.
Andraka-Christou, B., Gabriel, M., Madeira, J., & Silverman, R. D. (2019). Court personnel attitudes towards medication-assisted treatment: A state-wide survey. J Subst Abuse Treat, 104, 72-82. doi:10.1016/j.jsat.2019.06.011
This article provides insight into the attitudes of justice professionals on MOUD treatment for the justice involved population. Study participants were employees in the state court and criminal justice systems, including judges, probation officers, law enforcement officers, health care practitioners, defense attorneys, prosecutors, and others. This article concluded that court employees’ attitudes significantly differ by medication, with average attitudes towards agonist medications being more negative than attitudes towards extended-release naltrexone, despite a larger evidence base for the efficacy of methadone and oral buprenorphine. Justice personnel may have more positive attitudes towards extended-release naltrexone due to targeted marketing by the pharmaceutical manufacturer, fears about diversion or misuse of agonist medications, and historic criminal justice hostility towards agonist medications. Importantly, previous education/training regarding MAT is associated with more positive attitudes, suggesting that more awareness-raising or capacity building educational interventions are needed, especially for prosecutors and law enforcement personnel. This resource would be useful for any justice professional interested in learning more about the subject.
Aronowitz, S. V., & Laurent, J. (2016). Screaming Behind a Door: The Experiences of Individuals Incarcerated Without Medication-Assisted Treatment. J Correct Health Care, 22(2), 98-108. doi:10.1177/1078345816634079
This dissertation by Shoshana Aronowitz highlights the experiences of withdrawal and being tapered from opioid treatment upon incarceration. She reports that being withheld from opioid treatment is an extremely stressful experience for many individuals, and this may in turn create issues for both inmates and facility staff. This is a good resource for anyone interested in discovering ways in which addiction treatment is handled in prison, the impacts of that, and what might be done better.
Banta-Green, C. J., Floyd, A. S., Vick, K., Arthur, J., Hoeft, T. J., & Tsui, J. I. (2019). Opioid Use Disorder Treatment Decision Making And Care Navigation Upon Release From Prison: A Feasibility Study. Subst Abuse Rehabil, 10, 57-67. doi:10.2147/SAR.S192045
This article documents the implementation of an intervention to link participants to ongoing MOUD and psychosocial supports following release from prison. Results show that early linkage to care is feasible and has broad acceptability among participants. However, due to low enrollment, the study intervention did not demonstrate the intended effect to facilitate use of MOUD immediately post-release. Nonetheless, this article provides insight into the benefits and limitations of this intervention, and creates an argument for introduction of prerelease medication initiation and that a two-part intervention should be studied in systems that initiate MOUD prior to release. This is a good article for those interested in learning more about the feasibility of MOUD care navigation post-release.
Barglow, P. (2018). Commentary: The opioid overdose epidemic: Evidence-based interventions. Am J Addict, 27(8), 605-607. doi:10.1111/ajad.12823
This article explores the three interventions targeting opioid overdose among justice-involved populations: (1) Demand Reduction counsels and educates patients and current or potential opioid users about risks and treatment options to reduce motivation to consume opioids. (2) Supply Reduction limits access and dosage of opioids and co-drugs such as benzodiazepines. It encourages use of safest prescribing practices for treating pain. (3) Harm Reduction reduces opioid deaths through medication-assisted treatment (MAT) combining opioid substitution therapy (OST), provision of opioid antagonists like Naltrexone, and behavioral health services. The authors have concluded that although Harm Reduction is the safest, most effective single approach, combining three interventions while improving pain and addiction prescribing practices is optimal. This article is useful for program managers, advocates, and professionals working in corrections to expand their understanding of available treatment interventions for OUD.
Binswanger, I. A. (2019). Opioid Use Disorder and Incarceration – Hope for Ensuring the Continuity of Treatment. N Engl J Med, 380(13), 1193-1195. doi:10.1056/NEJMp1900069
In this journal article, Dr. Ingrid A. Binswanger provides insight into her experience as a provider managing MOUD for justice involved populations and the risks of mandatory withdrawal upon entry into correctional systems. She supplements the writing through personal anecdotes with her patients, all grounded in the legal and judicial systems that govern MOUD treatment rules and regulations in correctional facilities within the state. This article will be useful for anyone interested in learning more about the system of MOUD treatment from a clinical perspective.
Bone, C., Eysenbach, L., Bell, K., & Barry, D. T. (2018). Our Ethical Obligation to Treat Opioid Use Disorder in Prisons: A Patient and Physician’s Perspective. J Law Med Ethics, 46(2), 268-271. doi:10.1177/1073110518782933
This article provides an argument from both patients and providers perspectives of the ethical arguments surrounding MOUD treatment for incarcerated individuals. This article would be useful for anyone interested in learning more about these arguments, especially for those involved with criminal law and the justice system.
Brezel, E. R., Powell, T., & Fox, A. D. (2019). An ethical analysis of medication treatment for opioid use disorder (MOUD) for persons who are incarcerated. Substance Abuse, 1-5. doi:10.1080/08897077.2019.1695706
Using ethical principles of beneficence/non-maleficence, justice, and autonomy, in addition to public health ethics, this article evaluates the ethicality of addiction treatment policies in incarcerated settings. Given the strong evidence base of medical care for OUD, the authors conclude that making MOUD inaccessible in jails and prisons is ethically impermissible. This is a useful resource for law professionals and professionals involved in correctional facilities, as well as anyone interested in learning more about the ethical arguments for MOUD treatment in correctional facilities.
Brinkley-Rubinstein, L., McKenzie, M., Macmadu, A., Larney, S., Zaller, N., Dauria, E., & Rich, J. (2018). A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release. Drug Alcohol Depend, 184, 57-63. doi:10.1016/j.drugalcdep.2017.11.023
This article presents the results of a randomised control trial (RCT) that studies long-term impacts of providing methadone maintenance treatment (MMT) for incarcerated individuals post-release. The results found that 12 months post-release individuals who received continued access to MMT while incarcerated were less likely to report using heroin and engaging in injection drug use in the past 30 days. In addition, they reported fewer non-fatal overdoses and were more likely to be continuously engaged in treatment in the 12-month follow-up period compared to individuals who were not receiving methadone immediately prior to release. This article is a good resource for anyone wishing to learn more about the impacts of improving MOUD treatment access for incarcerated individuals within the system and post-release.
Brinkley-Rubinstein, L., Peterson, M., Clarke, J., Macmadu, A., Truong, A., Pognon, K., . . . Rich, J. D. (2019). The benefits and implementation challenges of the first state-wide comprehensive medication for addictions program in a unified jail and prison setting. Drug Alcohol Depend, 205, 107514. doi:10.1016/j.drugalcdep.2019.06.016
This article describes the results of a qualitative study with 40 individuals who were incarcerated and enrolled in the medications for addiction treatment (MAT) program in Rhode Island (RI). It documents self-reported benefits of the program as well as challenges and areas in need of improvement. The findings suggest that correctional MAT programs are acceptable to targeted populations and are a feasible intervention that may be transferable to other states. This is a useful article for those interested in understanding the more nuanced details of MAT programs in correctional facilities.
Brolin, M., Dennehy, K., Booxbaum, A., & Horgan, C. (2015). Improving Access to Substance Abuse Treatment and Reducing Incarceration and Recidivism. Issue Brief (Mass Health Policy Forum)(44), 1-46.
This reference presents Massachusetts’ strategic plan to improve access to substance abuse treatment and reduce incarceration and recidivism within the state. The report recommends: (1) implementing a pre‐arrest program to divert low‐level drug offenders to treatment, (2) enhancing and expanding specialty courts throughout the state, (3) increasing access to medication‐assisted treatment (MAT), and (4) expanding a Medicaid enrollment program in DOC and HOC facilities to improve access to healthcare services immediately upon release. This is a useful resource for those interested in reading about state-level strategic planning to address the opioid crisis and overdose among populations involved with the justice system.
Burns, R. M., Pacula, R. L., Bauhoff, S., Gordon, A. J., Hendrikson, H., Leslie, D. L., & Stein, B. D. (2016). Policies related to opioid agonist therapy for opioid use disorders: The evolution of state policies from 2004 to 2013. Substance Abuse, 37(1), 63-69. doi:10.1080/08897077.2015.1080208
This article highlights the evolution of state policies facilitating or hindering access to opioid agonists among Medicaid enrollees. The authors found that there appears to be a trend for states to enact policies increasing Medicaid coverage of opioid agonist therapies, while in recent years also enacting policies, such as prior authorization requirements, that potentially serve as barriers to opioid agonist therapy utilization. This is a useful resource for policymakers and lawyers interested in learning more about the shifting policies surrounding MOUD treatment access.
Csete, J., Kamarulzaman, A., Kazatchkine, M., Altice, F., Balicki, M., Buxton, J., . . . Beyrer, C. (2016). Public health and international drug policy. Lancet, 387(10026), 1427-1480. doi:10.1016/s0140-6736(16)00619-x
This resource explores the health impacts of drug policies through an international perspective. The authors conclude that policies meant to prohibit or greatly suppress drugs are vigorously defended by many policy-makers as necessary to preserve public health and safety. However, this creates a parodox, where evidence suggests these policies have contributed directly and indirectly to lethal violence, communicable disease transmission, discrimination, forced displacement, unnecessary physical pain, and the undermining of people’s right to health. This is a good resource for anyone interested in learning more about the international drug policies to inform future policies on opioid treatment.
Ducharme, L. J., & Abraham, A. J. (2008). State policy influence on the early diffusion of buprenorphine in community treatment programs. Substance Abuse Treatment, Prevention, and Policy, 3(1), 17. doi:10.1186/1747-597X-3-17
This study examines the net impact of efforts by state agencies, including provision of Medicaid coverage, on program-level adoption of buprenorphine as of 2006. The authors have found that inclusion of buprenorphine on state Medicaid formularies appears to be a key element in ensuring that patients have access to this state-of-the-art treatment option. This is a good resource for anyone interested in exploring the differences of access to MOUD treatment for both public sector clients and for-profit sector clients (including privately-insured clients).
Farahmand, P., Modesto-Lowe, V., & Chaplin, M. M. (2017). Prescribing Opioid Replacement Therapy in U.S. Correctional Settings. J Am Acad Psychiatry Law, 45(4), 472-477.
This article offers a rationale for providing opioid replacement therapies (ORT) to addicted prisoners while incarcerated and providing appointments with outpatient providers for continued treatment. This is a good resource for policy makers, lawyers, and professionals involved in the correctional system to better understand the evidence-based reasons for improving access to opioid treatment for recently incarcerated individuals.
Ferguson, W. J., Johnston, J., Clarke, J. G., Koutoujian, P. J., Maurer, K., Gallagher, C., . . . Taxman, F. S. (2019). Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails. Health Justice, 7(1), 19. doi:10.1186/s40352-019-0100-2
This article describes the process of implementing a medication assisted therapy (MAT) program in jails and prisons. This study highlights some of the success and limitations of implementing MAT programs in four different sites. The researchers identified government leadership, dedicated funding and collaboration with community treatment providers as essential to adoption of MAT during implementation phases. Adoption of the intervention varied by site, and only one site had reached sustainable adoption of MAT. Facilitators for MAT included increases in staffing and staff training; group education on medication assisted therapies; use of data to drive change processes; coordination with other elements of the criminal justice system to expand care; and ongoing contact with individuals postrelease to encourage continued treatment. Barriers included lack of funding and space and institutional design; challenges in changing the cultural perception of all approved treatments; excluding or discontinuing treatment based on patient factors, movement or transfer of individuals; and inability to sustain care coordination at the time of release.This is a useful resource for anyone interested in exploring best practices for implementing MOUD treatment programs in correctional facilities.
Finlay, A. K., Harris, A. H., Rosenthal, J., Blue-Howells, J., Clark, S., McGuire, J., . . . Binswanger, I. (2016). Receipt of pharmacotherapy for opioid use disorder by justice-involved U.S. Veterans Health Administration patients. Drug Alcohol Depend, 160, 222-226. doi:10.1016/j.drugalcdep.2016.01.013
This retrospective cohort study of veterans with an opioid use disorder diagnosis examined receipt of pharmacotherapy in the 1-year period following diagnosis as a function of justice involvement, adjusting for patient and facility characteristics. After logistic regression analysis, the authors discovered that compared to veterans not justice-involved, those prison-involved had 0.75 lower adjusted odds (95% confidence interval [CI]: 0.65–0.87) of receiving pharmacotherapy whereas jail/court-involved veterans did not have significantly different adjusted odds. They conclude that targeted efforts to increase receipt of pharmacotherapy for opioid use disorder among veterans exiting prison is needed.
Fox, A. D., Maradiaga, J., Weiss, L., Sanchez, J., Starrels, J. L., & Cunningham, C. O. (2015). Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: a qualitative study of the perceptions of former inmates with opioid use disorder. Addict Sci Clin Pract, 10, 2. doi:10.1186/s13722-014-0023-0
This qualitative study investigated barriers to and facilitators of buprenorphine maintenance treatment (BMT) following release from incarceration (“re-entry”). The authors found that many participants experienced painful withdrawal from methadone during incarceration and were fearful that using MAT would lead to opioid tolerance and painful withdrawal again in the future. Participants reported both positive and negative experiences taking illicit buprenorphine, which affected interest in BMT. Overall, BMT was perceived to be a good treatment option for opioid use disorder that could reduce the risk of re-incarceration. This article is a useful resource for those interested in learning more about the perspective of people receiving treatment for opioid addiction upon release from correctional facilities. It provides insight into motivations, perceived risks, and barriers to treatment access and uptake that can inform policy and program changes for MOUD treatment programs.
Friedmann, P. D., Hoskinson, R., Gordon, M., Schwartz, R., Kinlock, T., Knight, K., . . . Mat Working Group Of, C. J. D. (2012). Medication-assisted treatment in criminal justice agencies affiliated with the criminal justice-drug abuse treatment studies (CJ-DATS): availability, barriers, and intentions. Subst Abus, 33(1), 9-18. doi:10.1080/08897077.2011.611460
This article presents a study that surveyed criminal justice agencies affiliated with the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) to assess use of medication-assisted treatment (MAT) and factors influencing use of MAT. The authors found that factors influencing use of MAT included criminal justice preferences for drug-free treatment, limited knowledge of the benefits of MAT, security concerns, regulations prohibiting use of MAT for certain agencies, and lack of qualified medical staff. This is a useful resource for justice professionals and anyone else interested in understanding the various ways in which different criminal justice agencies perceive use of MAT in correctional facilities.
Friedmann, P. D., Wilson, D., Hoskinson, R., Jr., Poshkus, M., & Clarke, J. G. (2018). Initiation of extended release naltrexone (XR-NTX) for opioid use disorder prior to release from prison. J Subst Abuse Treat, 85, 45-48. doi:10.1016/j.jsat.2017.04.010
This pilot study examined the feasibility and acceptability of extended release injectable naltrexone (XR-NTX) injection prior to prison release among adult inmates with opioid use disorder, followed by six months of community XR-NTX treatment. The authors concluded that initiation of XR-NTX injection prior to release from prison might be an effective approach to reduce relapse to opioids. However, these findings were limited by the small sample size, and larger clinical trials are needed to confirm these findings. Nonetheless, this is a useful resource for those interested in exploring the potential for XR-NTX to be used as treatment for opioid overdose for justice-involved populations.
Gordon, M. S., Vocci, F. J., Fitzgerald, T. T., O’Grady, K. E., & O’Brien, C. P. (2017). Extended-release naltrexone for pre-release prisoners: A randomized trial of medical mobile treatment. Contemp Clin Trials, 53, 130-136. doi:10.1016/j.cct.2016.12.015
This article describes the design of a randomized controlled trial (RCT) that utilizes the combination of two interventions to address opioid overdose among justice involved populations, specifically by improving access to treatment. The researchers provide recently released study participants with extended-release naltrexone (XR-NTX) injections while utilizing mobile medical treatment. The primary outcomes are: treatment adherence; opioid use; criminal activity; re-arrest; reincarceration; and HIV risk-behaviors. This is a useful resource for professionals interested in crafting and implementing a similar study among people living with opioid addiction in correctional facilities.
Green, T. C., Clarke, J., Brinkley-Rubinstein, L., Marshall, B. D. L., Alexander-Scott, N., Boss, R., & Rich, J. D. (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
This research letter describes the results of implementing a comprehensive MAT program correctional facilities in Rhode Island. The authors conclude that a large and clinically meaningful reduction in post-incarceration deaths from overdose among inmates released from incarceration after implementation of the statewide program was observed, contributing to an overall state population-level decline in overdose deaths. This article is a good reference for policymakers, advocates, and justice involved professionals to use as evidence in support of MOUD treatment for people living with opioid use disorder in correctional facilities.
Lincoln, T., Johnson, B. D., McCarthy, P., & Alexander, E. (2018). Extended-release naltrexone for opioid use disorder started during or following incarceration. J Subst Abuse Treat, 85, 97-100. doi:10.1016/j.jsat.2017.04.002
This article presents an observational study conducted in a western Massachusetts county jail that initiated extended-release naltrexone (XR-NTX) prior to release from incarceration and linkage of participants to community treatment providers upon release. This article explores the success and barriers towards this program, as well as retention on medication-assisted treatment (MAT) programs. This article concludes that receiving XR-NTX prior to jail release for opioid use disorder appears to increase the treatment retention rate as compared to commencing after release. This article serves as a useful reference for supporting expanding availability of opioid agonist treatments prior to release and other evidence-based supports and retention strategies in the community.
Ludwig, A. S., & Peters, R. H. (2014). Medication-assisted treatment for opioid use disorders in correctional settings: an ethics review. Int J Drug Policy, 25(6), 1041-1046. doi:10.1016/j.drugpo.2014.08.015
This article explores the implications of current correctional policies through the ethical principles of: (1) beneficence/non-maleficence; (2) distributive justice (equivalence-of-care); and (3) autonomy (informed consent). Findings highlight that these core ethical principles support the adoption of correctional policies that include MAT. This is a useful resource for anyone wishing to understand the ethics of MOUD treatment through the framework of the Belmont Report.
Macmadu, A., Goedel, W. C., Adams, J. W., Brinkley-Rubinstein, L., Green, T. C., Clarke, J. G., . . . Marshall, B. D. L. (2020). Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails. Drug Alcohol Depend, 208, 107858. doi:10.1016/j.drugalcdep.2020.107858
The objective of this article is to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality. Data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature was used to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016. The authors found that prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population. This article serves as a useful resource that provides evidence-based results of the impact of MOUD treatment program integration in correctional facilities.
McMillan, G. P., Lapham, S., & Lackey, M. (2008). The effect of a jail methadone maintenance therapy (MMT) program on inmate recidivism. Addiction, 103(12), 2017-2023. doi:10.1111/j.1360-0443.2008.02361.x
This article described a prospective, longitudinal, observational study that evaluates the effects of a jail-based continuation of methadone maintenance therapy (MMT) on subsequent inmate recidivism risks. The authors found that there is no support for or against either argument that jail-based MMT will increase or reduce inmate recidivism. These results should encourage corrections administrators who are concerned that providing MMT in the jail will reduce the deterrent effects of jail time on MMT patients, if not actually motivating MMT patients to become incarcerated actively. Corrections administrators are further encouraged to promote jail-based MMT, as this may improve inmate linkage with outside MMT providers upon release from jail. The authors make an argument for promoting MOUD treatment on clinical grounds only, with no expected harm to public safety.
McMillan, G. P., & Lapham, S. C. (2005). Staff perspectives on methadone maintenance therapy (MMT) in a large southwestern jail. Addiction Research & Theory, 13(1), 53-63. doi:10.1080/16066350512331328159
The purpose of the study was to develop and test an instrument to measure knowledge about methadone maintenance treatment, attitudes towards drug addiction, readiness to adopt a methadone maintenance program, and to determine how the staff at a large metropolitan detention center score on these domains. The authors found that many staff members have strong and often polarized opinions about drug treatment in a correctional setting. Results of this study suggest several steps towards improving the staff support for methadone maintenance therapy, which includes better education regarding opiate replacement therapy as an effective treatment for heroin addiction. This is a good reference for anyone seeking to better understand staff perspectives and ways to improve staff attitudes toward MOUD treatment in corrections.
Moller, L. F., Matic, S., van den Bergh, B. J., Moloney, K., Hayton, P., & Gatherer, A. (2010). Acute drug-related mortality of people recently released from prisons. Public Health, 124(11), 637-639. doi:10.1016/j.puhe.2010.08.012
This article documents the national epidemic of acute drug-related mortality or recently released individuals, providing possible response and necessary networks that can be implemented and built to address this growing crisis. This is a useful resource to ground the reader in the challenges and potential solutions that exist to the growing opioid overdose epidemic in the US.
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. J Subst Abuse Treat, 99, 32-43. doi:10.1016/j.jsat.2018.12.003
This meta-analysis and systematic review examined the state of the literature on the effectiveness of medication assisted treatment (MAT; methadone, buprenorphine, naltrexone) delivered in prisons and jails on community substance use treatment engagement, opioid use, recidivism, and health risk behaviors following release from incarceration. Results provide the first meta-analytic summary of MATs delivered in correctional settings and support the use of MATs, especially with regard to community substance use treatment engagement and opioid use. This resource shows strong support for the utility of MAT in increasing community-based substance-use treatment engagement post-incarceration in prison and jail, and strong support for the use of methadone in reducing illicit opioid use and injection drug use post-incarceration.
Murphy, S. M., & Polsky, D. (2016). Economic Evaluations of Opioid Use Disorder Interventions. Pharmacoeconomics, 34(9), 863-887. doi:10.1007/s40273-016-0400-5
The purpose of this study was to review the literature on economic evaluations of opioid use disorder interventions. In general, the authors found that the evidence on methadone-maintenance therapy (MMT) supports previous findings that MMT is an economically advantageous opioid-use-disorder therapy. However, the existing economic evaluation literature pertaining to buprenorphine/naloxone maintenance therapy (BMT) and naltrexone is limited at this point, particularly for naltrexone. This is a useful resource for anyone interested in understanding the economic implications of MOUD treatment in corrections.
Peeler, M., Fiscella, K., Terplan, M., & Sufrin, C. (2019). Best Practices for Pregnant Incarcerated Women With Opioid Use Disorder. J Correct Health Care, 25(1), 4-14. doi:10.1177/1078345818819855
This article provides recommended strategies to optimize the care of pregnant incarcerated women with OUD, emphasizing the importance of appropriate counseling and treatment with opioid agonist pharmacotherapy.
Peterson, M., Rich, J., Macmadu, A., Truong, A. Q., Green, T. C., Beletsky, L., . . . Brinkley-Rubinstein, L. (2019). “One guy goes to jail, two people are ready to take his spot”: Perspectives on drug-induced homicide laws among incarcerated individuals. Int J Drug Policy, 70, 47-53. doi:10.1016/j.drugpo.2019.05.001
This article examines the impacts of drug-induced homicide laws (such as deterrence from calling 911 and increased violence) and how these laws may be contributing to the rising rates of opioid overdose. In addition, the authors describe how these laws may in fact undermine the efforts of MOUD treatment for justice involved populations. This is a useful reference for anyone wishing to learn more about the impacts of opioid laws, particularly for policymakers and lawyers.