OBJECTIVES: Opioid use disorder (OUD) is common among incarcerated, but access to FDA-approved medications for OUD (MOUD) is limited. The purpose of this study was to develop a novel model framework to assess the cost impact of implementing a MOUD program within the criminal justice system (CJS).

METHODS: A targeted literature review was conducted using Ovid MEDLINE, Emcare (via Ovid), Embase, Econlit, and EBM Reviews databases to identify 8 previous economic evaluations of MOUD programs within CJS. Economic analyses and cost data on MOUD programs within CJS were limited. Stakeholders (correctional Medical Director and Clinical Advisor) and researchers were engaged to advise on model components, usability and to inform decision-making in MOUD coverage within CJS. A novel model framework was developed to assess program costs and cost offsets to CJS and taxpayers; and a cost impact model was built to compare scenarios providing MOUD (methadone, oral buprenorphine, buprenorphine extended-release, and extended-release naltrexone). We hypothesized that program implementation costs and potential cost offsets from reduced OUD-related events contributed to the total costs of MOUD programs. The pre-release phase (CJS perspective) and post-release phase (taxpayer perspective) were considered, each including direct costs of MOUD provisions and cost offsets from preventing OUD-related events. Direct costs included drug, facility, staff, and supply costs categorized as fixed, step-fixed, time-dependent, or variable costs. Pre-release cost offsets included staff costs avoided due to drug diversion, disciplinary infraction, and medical costs avoided due to overdose. Within six months post-release, avoided fatal and non-fatal overdose and recidivism were counted as costs offsets to continued MOUD treatment to taxpayers.

RESULTS: N/A

CONCLUSIONS: This cost impact analysis framework and model captured core components of CJS costs to assess the economic impact of implementing different MOUD programs within CJS. Future research will consider a broader societal perspective including costs associated with lost productivity and premature mortality.