Coordinator-Led Medication Treatment Across Two County Jails
A Sheriff-Backed Model That Grew From a Few Dozen People to More Than 250
The Santa Barbara County Sheriff's Office runs a medication for opioid use disorder program across its two jails, delivered mainly through its health contractor Wellpath, so that people in custody can start or continue treatment and leave with medication and a community follow-up appointment already scheduled.
The Challenge They Were Addressing
Santa Barbara County was tracking a rising toll from opioids. The sheriff reviews county overdose death numbers regularly, and at one point the county recorded more than 200 overdose deaths in a year, many of them tied to opioids. People cycling through the county jails were among those facing overdose risk, and a jail stay was a point of contact where treatment could begin or continue.
When the program started, medication for opioid use disorder in the jails faced several practical limits. Some staff and some medical providers were hesitant about treating opioid use disorder with medication, and that hesitancy slowed early growth. Staffing capacity and previous limits to providers' ability to prescribe OUD medications capped the number of people who could be served, resulting in a waitlist of 30 to 50 people who could not get into treatment. The cost of medications, including long-acting injectables, was a real barrier before dedicated funding existed.
There was also a gap at the time of release. People leaving custody needed a way to keep their medication and connect to community treatment rather than losing continuity at the jail door. Closing that gap became a central goal of the program as it grew.
What They Built
The county built an in-house jail MAT model delivered primarily through its health contractor, Wellpath. Most services happen inside the two jails rather than by transferring people out. The one routine exception is methadone, which the local opioid treatment program, Aegis, brings into the jail for the people who need it.
The process starts at booking. A registered nurse conducts the intake, which now includes a detailed set of questions covering substance use history and mental health. If someone reports substance use or is already receiving MAT in the community, they are flagged for the MAT coordinator, who follows up the next business day. When someone is continuing community treatment or needs urgent evaluation, the on-call physician can start medication right away. For most people, the MAT coordinator screens, coordinates with the physician, and orders the medication.
Medication is delivered in custody. Because neither jail has a centralized MAT clinic, staff use different locations, including multipurpose rooms and classrooms, where a group of people can line up, receive their medication, and be observed for a set period. Counselors funded through the program provide support to people in treatment.
Release planning is built into the coordinator's role. As a release approaches, the MAT coordinator ensures the person leaves with medications in hand (time varies based on physician discretion), a prescription in hand, and an appointment already set with county health or Aegis. The program uses several medications, including Suboxone, Sublocade, Brixadi, naltrexone, and methadone. Beginning in October 2026, the county plans to screen people for Medi-Cal and bill through California's CalAIM initiative, which reimburses correctional facilities for covered services; that work is in progress now.
Key Program Components
Who You Need at the Table
What made a willing partner essential vs. optional?
The required partners are the ones the program cannot run without. Wellpath delivers most of the clinical work, from intake screening to the MAT coordinator role to counseling. The sheriff's office provides the custody setting and the leadership support that make growth possible. The county health department administers the settlement funding and provides the community treatment to which people are referred upon release. Aegis fills the one clinical piece the jail does not handle in-house by bringing methadone into the facility.
Helpful partners extend the model without being essential to daily operations. The California jail MAT cohort provided the initial push and the first funding; county fiscal staff keep spending within allowable uses; and local police departments feed into the booking process.
Budget Breakdown
What is the minimum viable budget to replicate this?
A minimum viable version does not require the full budget Santa Barbara now uses. The floor is a MAT coordinator role, plus a reliable way to pay for medication. Early in Santa Barbara's program, a single coordinator supported 10 to 30 people, with counseling and expanded medication funding added later as money became available. A smaller county could start with continuations and urgent evaluations, then grow into inductions and counseling once staffing and medication funding are in place.
What Worked and Why
Specific decisions or design features that drove success
Sheriff and custody leadership support gave the program room to grow. The sheriff tracks county overdose deaths closely and backs medication treatment in the jails, which helped the program move past early hesitancy among some staff and providers.
Joining the state jail MAT cohort at the start meant the county did not have to invent its model from nothing. The cohort funded the first coordinator and connected the county with peers it could learn from.
A strong MAT coordinator role turned out to be the engine of the program. When a new coordinator came on, they pushed on why so many people were on a waitlist and how many more could be served, and the program grew from a few dozen people to more than 250, about a third of the jail population.
Settlement funding removed the medication cost barrier. Once dedicated funds covered long-acting injectables and other MAT medications, the question shifted from how to afford treatment to how to serve everyone who needed it. Two additional counselors gave the program the capacity to expand beyond continuations to include new inductions.
Providing medication broadly, including long-acting injectables, also helped reduce the risk of medication diversion inside the jails. After an earlier stretch that included overdose incidents in custody, expanding access and using longer-acting formulations coincided with fewer such problems. Building release planning into the coordinator's role kept continuity of care at the center of the model.
Early outcomes and data
More than 250 people are on MAT across the two jails, roughly one-third of the jail population.
Growth from an early range of about 10 to 30 people to more than 250 as capacity and funding expanded.
A past waitlist of 30 to 50 people that the program worked to eliminate as it grew.
Two substance use counselors were added through settlement funding, expanding counseling capacity.
Release planning that sends people out with up to 30 days of medication or a prescription and a scheduled follow-up.
Overdose statistics are tracked by the jail, with efforts to match cases to recent incarceration.
CalAIM/Medi-Cal screening and reimbursement workflow is scheduled to begin in October 2026 and is now in progress.
Lessons Learned
Put a coordinator at the center. The MAT coordinator drove the program's growth by pushing on the waitlist and leading follow-up and release planning. This single role does more than any other to make the model work.
Remove the medication cost barrier early. Once dedicated funding covered long-acting injectables and other medications, the program could serve everyone who needed treatment rather than rationing care based on cost.
Grow capacity and medication funding together. Adding two counselors alongside expanded medication funding allowed the program to move from continuations into new inductions without leaving people on a waitlist.
Plan movement and space around the medication, not the other way around. With two jails about 70 miles apart, no centralized clinic, and staffing constraints for women, medication delivery must be designed around real-world custody logistics.
Build release continuity into the model. Sending people out with medication and a scheduled appointment keeps treatment going after custody and is where much of the long-term value sits.
Consider longer-acting medications to manage diversion. After an earlier period with overdose incidents in custody, expanding access and using longer-acting formulations coincided with fewer diversion-related problems.