Does a state mandate translate into jail policy? Evidence from a policy surveillance study of opioid use disorder care in Colorado jails

BACKGROUND: People with opioid use disorder (OUD) are disproportionately represented in US jails, yet access to evidence-based treatment remains limited. In May 2022, Colorado enacted House Bill 22-1326, which mandated that all county jails provide medications of OUD (MOUD). This study sought to describe Colorado jail policies for OUD treatment after the 2022 state mandate and explore differences by county characteristics. METHODS: We conducted a policy surveillance study of all Colorado jail policies, including public-facing and requested policies, for the treatment of OUD between June and October 2024. We selected the OUD Cascade of Care framework a priori to guide data abstraction and identified jail policies for MOUD availability, peer support services, harm reduction services, and linkage to community-based treatment at the time of release. RESULTS: Of Colorado's 46 county jails, 28 (61%) had public-facing policies and/or provided information upon request. Of the 28 policies reviewed, OUD screening (n = 20; 71%), MOUD provision (n = 19; 67%), and post-release linkage to care (n = 17; 63%) were most frequently described. Additional services included counseling (n = 16; 59%), peer support services (n = 7; 26%), and harm reduction interventions (n = 6, 22%). Urban jails generally had more policy elements than rural jails. CONCLUSIONS: Although MOUD is mandated in all Colorado jails, nearly two in five jails lack publicly available policies on OUD treatment and a minority of available policies indicated that all forms of MOUD were provided. Greater transparency may improve accountability and provide opportunities to support jails in implementing model policies to ensure evidence-based OUD treatment is available for all incarcerated individuals.