{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:37:06Z","timestamp":1792888626417,"version":"4.5.0"},"reference-count":56,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Most prisons and jails in the US discontinue medications for opioid use disorder (MOUD) upon incarceration and do not initiate MOUD prior to release.<\/jats:p><\/jats:sec>Objective<\/jats:title>To model the association of MOUD access during incarceration and at release with population-level overdose mortality and OUD-related treatment costs in Massachusetts.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This economic evaluation used simulation modeling and cost-effectiveness with costs and quality-adjusted life-years (QALYs) discounted at 3% to compare MOUD treatment strategies in a corrections cohort and an open cohort representing individuals with OUD in Massachusetts. Data were analyzed between July 1, 2021, and September 30, 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Three strategies were compared: (1) no MOUD provided during incarceration or at release, (2) extended-release (XR) naltrexone offered only at release from incarceration, and (3) all 3 MOUDs (naltrexone, buprenorphine, and methadone) offered at intake.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Treatment starts and retention, fatal overdoses, life-years and QALYs, costs, and incremental cost-effectiveness ratios (ICERs).<\/jats:p><\/jats:sec>Results<\/jats:title>Among 30\u202f000 simulated incarcerated individuals with OUD, offering no MOUD was associated with 40\u202f927 (95% uncertainty interval [UI], 39 001-42 082) MOUD treatment starts over a 5-year period and 1259 (95% UI, 1130-1323) overdose deaths after 5 years. Over 5 years, offering XR-naltrexone at release led to 10\u202f466 (95% UI, 8515-12 201) additional treatment starts, 40 (95% UI, 16-50) fewer overdose deaths, and 0.08 (95% UI, 0.05-0.11) QALYs gained per person, at an incremental cost of $2723 (95% UI, $141-$5244) per person. In comparison, offering all 3 MOUDs at intake led to 11\u202f923 (95% UI, 10 861-12 911) additional treatment starts, compared with offering no MOUD, 83 (95% UI, 72-91) fewer overdose deaths, and 0.12 (95% UI, 0.10-0.17) QALYs per person gained, at an incremental cost of $852 (95% UI, $14-$1703) per person. Thus, XR-naltrexone only was a dominated strategy (both less effective and more costly) and the ICER of all 3 MOUDs compared with no MOUD was $7252 (95% UI, $140-$10\u202f018) per QALY. Among everyone with OUD in Massachusetts, XR-naltrexone only averted 95 overdose deaths over 5 years (95% UI, 85-169)\u2014a 0.9% decrease in state-level overdose mortality\u2014while the all-MOUD strategy averted 192 overdose deaths (95% UI, 156-200)\u2014a 1.8% decrease.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this simulation-modeling economic study suggest that offering any MOUD to incarcerated individuals with OUD would prevent overdose deaths and that offering all 3 MOUDs would prevent more deaths and save money compared with an XR-naltrexone\u2013only strategy.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.7036","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T15:01:25Z","timestamp":1681484485000},"page":"e237036","source":"Crossref","is-referenced-by-count":26,"title":["Estimated Costs and Outcomes Associated With Use and Nonuse of Medications for Opioid Use Disorder During Incarceration and at Release in Massachusetts"],"prefix":"10.1001","volume":"6","author":[{"given":"Avik","family":"Chatterjee","sequence":"first","affiliation":[{"name":"Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Weitz","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Savinkina","sequence":"additional","affiliation":[{"name":"Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandria","family":"Macmadu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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