Telemedicine-based buprenorphine initiation and maintenance in rural jails: a retrospective observational study

The persistent U.S. opioid overdose epidemic disproportionately affects incarcerated populations, who face a severely heightened risk of fatal overdose after release. Providing medications for opioid use disorder (MOUD) in jails significantly reduces post-release death and boosts community treatment engagement, making short-term carceral stays a vital window for intervention. But access to MOUD, especially in rural areas, is greatly hampered by logistical barriers, including provider shortages—a challenge that is met with the use of telemedicine. This study evaluates the reach, scalability, and implementation of a large-scale, multi-site tele-buprenorphine program designed to treat opioid use disorder (OUD) within rural carceral settings. We conducted a retrospective chart review of 842 unique patients (1,321 treatment episodes) enrolled in the University of Maryland’s tele-buprenorphine program across six rural county jails between June 2020 and May 2025. Data extracted from jail records and electronic health records were used to analyze patient demographics, prescribing patterns, and program retention. The patient population was primarily male (71.1%) and White (75.7%), with a mean age of 35.4 years. Participants reported high-severity OUD, with an average of 12.6 years of opioid use. Reflecting broad admission criteria, 55.2% of participants were new treatment initiates not receiving MOUD prior to booking. Patients spent a mean of 35.6 days incarcerated before initiation and were retained in the program for an average of 66 days. Buprenorphine doses were titrated from a mean initiation dose of 8.8 mg to 16.2 mg at discharge. The program demonstrated a 99.5% adherence rate among retained patients. Only 3% of the total sample were discharged for medication diversion or hoarding. Telemedicine is a highly feasible and scalable model for delivering evidence-based MOUD in rural jails. By utilizing a “liberal admission policy” that prioritizes both treatment initiation and maintenance, programs can successfully reach high-risk individuals who lack access to community-based care. These findings suggest that tele-buprenorphine can effectively bridge the treatment gap in underserved jurisdictions, potentially reducing the risk of overdose during the high-risk post-release period.