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MethodsThis was a retrospective observational study using linked jail and state public health data in seven MA county jails between September 2019 and December 2020.Individuals with probable OUD received treatment with methadone, buprenorphine, naltrexone, or no MOUD while in jail, per local standard care.Primary outcomes were post-release treatment with MOUD, opioid overdose, reincarceration, and death from any cause.Propensity score weighting was used to adjust for measured baseline differences. ResultsThe cohort included 6,400 participants, of whom 2711 (42.4%) received MOUD and 3,689 (57.6%) did not.Median age was 36 years, and most subjects (74.7%) were male.Nearly 74% of treated participants were already receiving MOUD at jail entry compared to 17% of untreated participants.Buprenorphine was given most frequently (68%), followed by methadone (26%) and extended-release naltrexone (6.5%).Individuals who received MOUD in jail were more likely to continue MOUD post-release.Receipt of MOUD in jail was also associated with a significantly lower risk of fatal opioid overdose (adjusted odds ratio: 0.48; 95% confidence interval: 0.36 -0.64), nonfatal opioid overdose (aOR 0.76; 95% CI: 0.68 -0.85), reincarceration (aOR: 0.88; 95% CI: 0.81 -0.94), and death from any cause (aOR: 0.44; 95% CI: 0.35 -0.56). ConclusionReceipt of MOUD during jail incarceration was associated with greater continuation of OUD treatment post-release and with lower risks of opioid overdose, reincarceration, and all-cause mortality.The findings support routine continuation and initiation of MOUD in correctional settings with strong continuity to community treatment after release.