We obtained monthly aggregate data over 29 months from the electronic health records of the Maricopa County jail system (n = 177,074 detainees). All detainees are screened for symptoms of active opioid withdrawal using the Clinical Opioid Withdrawal Scale (COWS).

A total of 31,613 (17.8%) of detainees entering the Maricopa County jail system during the study period screened positive for active signs of opioid withdrawal and placed on withdrawal protocol. Of those placed in withdrawal protocol,13,343 (42.2%) detainees were categorized as low risk, and 18,270 ( 57.7%) as high risk. A total of 2,782 inmates received methadone 17.8% of inmates at risk for opioid withdrawal. For these prescriptions, 65.5% (1824) were new methadone prescriptions, while 34.4% (958) existing methadone prescriptions.

A total of 9% of detainees who screened at risk for opioid withdrawal received MAT education and medication assisted treatment. Recommendation are made on how to expand uptake of MAT services for jail detainees. Results of this study indicates there is an opportunity to intervene and improve outcomes for a justice-involved population that experiences significant disparities and is highly vulnerable to opioid-related overdose.