Pennsylvania is expanding access to medications for opioid use disorder (MOUD) for people in county jails, both during incarceration and upon release. The change reflects a growing recognition among corrections officials that naltrexone does not produce the same outcomes as the other two Food and Drug Administration-approved MOUD, as well as the reluctance to do more than incremental change.
In 2015 Pennsylvania launched Act 80, a pilot program funding access to “nonnarcotic” MOUD, which refers to just naltrexone. Better known by brand name Vivitrol, naltrexone is an opioid antagonist—the same class of medication as overdose-reversal agents naloxone and nalmefene. It’s the third FDA-approved MOUD along with methadone and buprenorphine, but unlike those two does not have a solid body of evidence showing that it reduces risk of overdose. There is, however, significant concern that it increases risk of overdose, to the point that its FDA labeling is required to carry a warning about it.
At least $7.7 million in “uncommitted” funds from Act 80 is now expected to be made available through the state’s county jail MOUD grant program within the next few weeks. Those funds can go toward any of the three MOUD. An additional $1.75 million has been newly appropriated for just naltrexone. The Pennsylvania Commission on Crime and Delinquency (PCCD) and Department of Drug and Alcohol Programs announced the change November 21.
Vivitrol is formulated as a monthly injection, whereas methadone and buprenorphine are generally dispensed as daily oral medications. While injectable medications can be more expensive, the cost-savings appeal for corrections departments lies in not needing staff to supervise daily dosing.
Some Pennsylvania jails may be considering using the funds to provide Sublocade, the monthly injectable version of buprenorphine, in addition to Vivitrol. On November 21, Clearfield County Jail was authorized to switch from oral MOUD to injectable.
In December, the PCCD is expected to announce the grant awards for a separate $12 million in state opioid response funding, focused on treatment and recovery resources for people involved in the Pennsylvania justice system.
Use of naltrexone in this context is an especially dire problem because overdose risk increases dramatically post-release.
In September, a large study backed by the National Institutes of Health highlighted how widely used naltrexone is in county jails compared to methadone and buprenorphine, despite the latter two being the MOUD actually shown to reduce overdose risk.
The use of naltrexone in this context is an especially dire problem because overdose risk upon re-entry to the community increases dramatically—it’s the leading cause of death for people recently released from incarceration. Research has estimated nearly one in five overdose deaths in the United States are among people newly released from county jails.
The issue of MOUD funds going unspent has been a recurring theme in correctional settings, and in harm-reduction funding in general. Earlier in November, legislators in New Mexico released a report describing how funds appropriated for MOUD access within the criminal-legal system “have not been fully utilized.” This included $10 million intended for juvenile detainees, none of which appears to be going toward that purpose.
In recent weeks, the number of people detained in the Los Angeles County jail system who are waitlisted for MOUD more than doubled following a new mandate that essentially limits treatment to new arrivals. An internal memo described county correctional health services administrators “taking a pause” on buprenorphine, according to CalMatters.
The jail system, which houses around 2,500 MOUD patients on a given day, is currently facing a lawsuit brought by the state of California centering around its disproportionate death rates. So far in 2025, more than one in four deaths in the LA County jail system has been attributed to overdose.
Image (cropped) via Blue Earth County, Minnesota