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A published May 5, 2025, in Health Affairs offers the first in-depth look at how individuals with opioid use disorder (OUD) experienced Maryland’s sweeping jail-based treatment law—House Bill 116—requiring access to all three FDA-approved medications for opioid use disorder (MOUD) in jails. Despite implementation challenges, most study participants credit the law with improving their chances of recovery and avoiding fatal overdose after release.

The study was co-authored by researchers from Johns Hopkins University including Health Policy and Management professor Brendan Saloner, PhD, as well as MPH;  Cosima Lenz, MPH; Minna Song, MPH; associate professor Carolyn Sufrin, MD, PhD; associate professor Alene Kennedy-Hendricks, PhD; Michael Fingerhood, MD; and assistant professor Sachini N. Bandara, PhD, MS. It draws on interviews conducted between January 2023 – March 2024 with 24 people who were incarcerated in Maryland jails. Many had previously experienced forced withdrawal during incarceration, a traumatic experience that heightens the risk of overdose upon release.

“Participants overwhelmingly saw MOUD in jail as a lifeline,” said Brendan Saloner. “This policy is saving lives. But we also heard loud and clear that there are serious gaps in how it’s being delivered—delays, stigma, and a lack of counseling that undermine its potential.”

Maryland’s HB116, passed in 2019, mandates all 24 counties to offer screening and treatment for OUD using methadone, buprenorphine, and naltrexone during incarceration and upon reentry. The law made Maryland one of the few states, along with New York, Massachusetts, and New Mexico, to require universal MOUD access in jails. However, the law didn’t allocate state funds or apply to prisons, which created inconsistencies in the rollout.

The participants, most of whom had been incarcerated multiple times, noted stark differences in treatment quality before and after the law’s implementation. For many, access to MOUD during recent jail stays marked a dramatic improvement in care. 

“One man told us that in the past, being incarcerated meant automatic withdrawal. But under HB116, he was able to access buprenorphine quickly and safely,” said Camille Kramer. “This made all the difference in helping him reenter society without turning back to illicit opioids.” 

Key Findings: Hope and Hurdles 

The study revealed four major themes from participant experiences: 

1. Improved Access and Recovery: Many participants said they previously had to endure withdrawal, but now could initiate or continue MOUD while incarcerated. Several attributed their successful recovery and avoidance of recidivism to the treatment they received under HB116.
2. Delays and Withdrawal: Despite the legal mandate, participants described long delays in treatment due to dose verification requirements, provider backlogs, and arbitrary staff discretion. These gaps sometimes led to preventable withdrawal symptoms. One participant said, “If you have a different disease, they’ll take care of it. But if you have addiction, it’s like you’re not worth helping.”
3. Stigma and Staff Attitudes: While a few participants praised compassionate staff, many said MOUD was treated as a compliance burden rather than a legitimate medical service. Patients were often stigmatized or called “junkies” by staff and described being made to feel like MOUD was a privilege rather than a right.
4. Limited Counseling and Education: Participants wanted more addiction counseling, both to aid their recovery and to better understand their treatment options. Upon release, many were not given information about different MOUD options or long-term support services.

Importantly, the study centers the voices of individuals directly affected by carceral health policy—voices too often left out of implementation planning. “It’s one thing to write a law and another to live through its rollout from inside a jail,” said Kramer. “Our research shows that while the policy created necessary change, compassion and coordination still lag. Maryland can—and must—do better.”

The study’s findings point to several ways the state can improve MOUD implementation, including by standardizing intake and dose verification protocols across facilities to avoid treatment delays; funding prison-based MOUD access since HB116 currently excludes state prisons; training staff to reduce stigma and improve understanding of addiction as a medical condition; and expanding counseling services and treatment education during incarceration and reentry.

The researchers stress that these changes require policy directives, investment, and leadership at the facility level. The law alone cannot close all gaps.

With fatal overdoses continuing to devastate communities, especially among recently incarcerated returning citizens, Maryland’s MOUD law offers a rare policy success that could serve as a national model. Yet, the study reminds policymakers and public health officials that full implementation requires attention to the lived experiences of those most impacted.

The study was supported by the National Institute on Drug Abuse (Grant No. 1R01DA057264) and presented at the 2025 Academic and Health Policy Conference on Correctional Health in Austin, Texas.