Immediate Medication Access for the General Jail Population
A Six-Person Clinical Team Continuing, Restarting, and Starting Medication in Custody
The Chesterfield County Sheriff’s Office uses opioid settlement funding to run Comprehensive Opioid Management and Patient Assistance for Substance Support Medication Assisted Treatment (COMPASS MAT), a dedicated jail-based team that delivers medication-assisted treatment with mental health and reentry supports for justice-involved people with opioid use disorder, continuing, restarting, and starting medication so that people leave custody without a gap in care.
The Challenge They Were Addressing
People were entering the Chesterfield County jail with opioid use disorder and needed medication without delay. The medical team had already treated people who arrived on Suboxone or methadone. Still, a clear gap remained: people who had used opioids and never been through a treatment program, and people who had been on medication two years earlier, relapsed, and arrived with no active prescription. With fentanyl and xylazine now common, withdrawal had become more severe than the team had seen a decade earlier, and medication had become a necessary clinical tool.
The county also faced a structural challenge. The Sheriff’s Office already runs Helping Addicts Recover Progressively (HARP), a well-known therapeutic community program with its own track and a waiting list. Opioid settlement rules do not allow new abatement funding to supplant existing services, so the county could not simply expand HARP to do this work. Jail leaders needed a way to deliver medication-assisted treatment to the general jail population, including people who did not want or could not yet enter a therapeutic community, without duplicating HARP.
Leadership reframed the question. A jail of this size holds one of the largest concentrations of people with substance use disorder in the community, which makes it one of the community’s largest points of access for detox and recovery. The Sheriff’s Office decided to build a separate, dedicated team to continue, restart, and start medication for opioid use disorder, with mental health and reentry supports wrapped around it.
What They Built
COMPASS MAT is a rapid-access medical team focused on medication-assisted treatment inside the jail. The team continues people who arrive already on medication, restarts people who were on medication in the past and relapsed, and starts new inductions. The medical side manages clinical assessment, prescribing, dosing, and monitoring, using Suboxone, Sublocade, Brixadi, naltrexone, and Vivitrol, and continuing methadone for people who arrive on it. The clinical lead and the behavioral health lead split duties so that one oversees the medical track and the other oversees the programming and treatment track.
This is structured as MAT services with mental health supports wrapped around it. The mental health clinician conducts screenings, triages patients, and provides education on medication-assisted treatment for the general population. The peer specialist runs reentry work, Medication-Assisted Recovery Anonymous (MORA) groups, and peer support. The case manager and the administrative assistant handle front-end screening and clear logistical hurdles so that the nurse practitioner and registered nurse can start people on medication when clinically appropriate.
The team built its weekly workflow around the realities of a working jail. Inductions are scheduled early in the week so that new starts fold into the regular medication administration schedule before the weekend, when staffing is lighter. Because pulling people from across the jail is difficult, the team also created a housing option, a pod next to the program space, for people who want therapeutic services. People choose their own path; no one is required to accept counseling to receive medication.
COMPASS is deliberately separate from HARP so that new opioid settlement funding does not supplant pre-existing services. HARP keeps its own track, and people waiting for HARP can receive medication and groups through COMPASS in the meantime. The medical team treats HARP participants the same way it treats anyone else. At the same time, the COMPASS clinician focuses on the general population to avoid duplicating the therapeutic supports HARP already provides. Release planning sends people out with medication in hand and follow-up appointments scheduled, so there is no gap when they return to the community.
Key Program Components
Who You Need at the Table
What made a willing partner essential vs. optional?
The partner that makes the model possible is leadership. A jail can deliver medication-assisted treatment only when the sheriff and command staff decide to do so and clear the way. Without that backing, a clinical team can make the case for the work but cannot guarantee it will continue. The clinical and behavioral health leads, the medical staff, and the peer and reentry staff each carry a required role, and custody staff is essential because nothing happens if people cannot be brought to the team safely.
Community treatment providers and the opioid abatement fund administrator are valuable without being required for day-one operations. Learning from how community treatment programs structure their clinical notes and workflow shaped how the jail team built its own, and the funding administrator’s rules shaped the decision to stand COMPASS up as a separate effort from HARP.
Budget Breakdown
What is the minimum viable budget to replicate this?
A county starting with a small budget does not need to fund the full six-person team on day one. The minimum viable version begins with medication continuation for people who already arrive with a prescription, which the law requires anyway, and is staffed by a clinician and a nurse. That keeps the load manageable while the team builds competence and workflow. As the team gains confidence, it can add high-risk screening and then new inductions. The recurring costs that cannot be cut are clinical staffing and medication; injectable medication, in particular, is a significant ongoing expense, and a replicating county should plan for it, as well as for substance and point-of-care testing, from the start.
What Worked and Why
Specific decisions or design features that drove success
Starting small was the decision that made the rest possible. Leadership began with medication continuation, the easier clinical load, and built workflow while operating, without waiting for perfect facilities or a complete team. The team describes this as building the plane while flying it, patching gaps as they arise.
Continuing existing medications first, before adding inductions, let the team get cohesive and work out its processes on a lower-risk caseload. People who relapsed and arrived without an active prescription were a more manageable starting point than new inductions, and restarting them first helped the team settle its workflow before expanding.
A dedicated team that concentrates only on medication-assisted treatment kept duties from being spread across the broader jail medical workload. Pairing that team with early-week induction scheduling solved a real operational clash: new starts now fold into the regular dosing schedule before the lighter-staffed weekend, so weekend nurses are not managing new induction starts.
Keeping COMPASS clearly separate from HARP solved both a compliance question and an operational one. Because opioid abatement funding cannot supplant pre-existing services, the team carved out distinct lanes: HARP keeps its therapeutic community track, COMPASS serves the general population, and reentry and clinician roles are split so people are not served twice for the same thing. The medical team still treats HARP participants like anyone else.
Learning from community treatment programs shortened the build. With no jail-based model to copy, the clinical lead drew on articles, treatment program conferences, and the structure of community providers’ clinical notes to design the jail’s own documentation and workflow, and then completed the required waiver training to start prescribing with confidence.
Early outcomes and data
97 people were on medication-assisted treatment in the jail at the time of the interview, the highest the team has recorded.
130 medication inductions completed to date, with people cycling in and out at the normal pace of a jail population.
Continuation, restart, and induction workflows operating across Suboxone, Sublocade, Brixadi, naltrexone, and Vivitrol, plus methadone continuation.
Early-week induction scheduling is adopted so new starts fold into the regular dosing schedule before the weekend.
Therapeutic housing pod option established next to the program space for people who want services.
Release planning is in place, so people leave with medication in hand and follow-up appointments scheduled.
Preliminary data have been submitted to the opioid abatement administrator since December and January, with year-end reporting in progress.
Lessons Learned
Start with continuation, then build toward inductions. Continuing people who already arrive on medication is the lowest-risk place to begin and is required by law. Build a team that can do continuations well, then add screening and new inductions as the team becomes more confident.
Expect a slower ramp than the timeline implies. Hiring took time, and the medical roles were the hardest to fill. Half the team was in place by winter, and the rest by spring, which meant the full team had only been operating together for about three months at the time of the interview. Plan for several months of building before the workflow settles.
Design the weekly workflow around how the jail actually runs. Scheduling inductions early in the week, so new starts fold into the regular dosing schedule before the lighter-staffed weekend, resolved a real clash. A workflow that ignores custody movement and weekend staffing will create avoidable friction.
Keep new opioid-funded work clearly separate from pre-existing services. Carving out distinct lanes from HARP kept the funding compliant and kept the team from serving people twice for the same thing. Plan that separation before spending.
Let people choose their own path. No one is required to accept counseling to receive medication. Screening everyone, then offering wraparound services to those who want them, keeps the focus on medication access while still providing mental health support, reentry help, and overdose prevention.
Sheriff Karl Leonard, LeonardK@chesterfield.gov