The opioid epidemic has been increasingly devastating communities in recent years. In 2020, roughly 2.7 million people in the United States (US) reported having an opioid use disorder (OUD) (Centers for Disease Control, 2022a) and 75% of drug overdose deaths involved an opioid (Centers for Disease Control, 2022b). Although drug addiction is a chronic medical condition requiring a public health approach to reduce harm, it continues to be criminalized (The Pew Charitable Trusts, 2022). More than half of those with OUD report involvement in the criminal legal system (Winkelman et al., 2018) and less than 10% of those with a drug dependency receive treatment while incarcerated (The Pew Charitable Trusts, 2022). In addition, there is racial bias in drug use enforcement. Although Black and White people in the US report similar rates of substance use, Black people are disproportionately incarcerated for drug charges at about six times the rate of White individuals (NAACP, 2023).

For individuals who are incarcerated, the risk of experiencing an overdose event is highest when transitioning from a correctional setting to the community, which could be due to reasons such as reduced drug tolerance and interruptions in OUD treatment (Binswanger et al., 2013, National Academies of Sciences, Engineering, and Medicine, 2019, Pizzicato et al., 2018, Ranapurwala et al., 2018). Non-fatal overdose is more common than fatal overdose (World Health Organization, 2021) and is a leading predictor of subsequent non-fatal and fatal overdose (Saloner et al., 2020, Caudarella et al., 2016, Krawczyk et al., 2020). Non-fatal overdoses are associated with a range of physical and mental morbidities including cardiac and renal conditions, post-traumatic stress disorder, and brain injury, as well as increased healthcare costs (Schneider et al., 2021, Degenhardt et al., 2019; U.S Department of Health and Human Services, 2019; Warner-Smith et al., 2002).

Several studies have demonstrated the benefits of methadone and buprenorphine, medications for OUD (MOUD), in prisons and jails. When provided during incarceration, MOUD has lowered mortality following release from jail (Bird et al., 2015, Degenhardt et al., 2014, Green et al., 2018, Huang et al., 2011, Lim et al., 2023, Marsden et al., 2017), reduced reincarceration (Westerberg et al., 2016) and self-reported drug use (Brinkley-Rubinstein et al., 2018, Heimer et al., 2006), improved engagement with community treatment (Brinkley-Rubinstein et al., 2018, Haas et al., 2021), and shown promise as a cost-effective intervention (Chatterjee et al., 2023). However, limited studies conducted in the US have examined the effect of MOUD provision in jail on non-fatal overdose events (Brinkley-Rubinstein et al., 2018, Haas et al., 2021). The impact of in-jail MOUD on non-fatal opioid overdoses, especially during the immediate time after release when risk of non-fatal overdose is particularly high, remains unclear. To address this gap in research, we examined whether enrollment in jail-based MOUD treatment is associated with lower risk of non-fatal opioid overdose among adults with OUD after release from New York City (NYC) jails to the community during 2011–2017.