Reversing an overdose, stabilizing someone in an emergency department, or completing a jail discharge addresses an immediate event. A community also needs an answer to the question of what comes next. Where can the person receive care, who will help them access it, and how will treatment continue when daily life becomes difficult? Substance use disorders belong in planning for community safety because preventing avoidable death and making treatment accessible are public responsibilities. A diagnosis should never be treated as evidence that someone is dangerous. People seeking recovery are community members whose safety matters.

Treatment can begin at the point of crisis

The National Institute on Drug Abuse describes emergency department initiation of buprenorphine as an opportunity to connect people with opioid use disorder to ongoing treatment. In a 2015 randomized study summarized by NIDA, about 80 percent of patients receiving emergency department buprenorphine with a brief intervention were engaged in treatment at 30 days, roughly twice the proportion in the referral comparison groups. That is evidence from a particular study, not a promised result for every emergency department.

The practical lesson is that a referral and an actual treatment connection are different accomplishments. Our recommendation is for local systems to arrange a receiving provider, address transportation and payment barriers, and establish who will follow up, with the person’s agreement. A phone number on discharge paperwork leaves those tasks unfinished.

Make release from jail a transition in care

A study of approximately 6,400 people with probable opioid use disorder in seven Massachusetts county jails found that receiving medication in jail was associated with better outcomes after release. NIH reported a 52 percent lower risk of fatal opioid overdose and greater treatment continuation among those receiving medication. The study was observational, so the association should not be presented as proof that medication alone caused every difference. Local leaders should ask how the jail’s health service coordinates with community clinicians before a person leaves. Our proposed standard is a discharge plan that addresses medication continuity, an accessible appointment for continuing care, resources for overdose prevention, and the practical arrangements needed to use them. Responsibility should be assigned to an actual team rather than assumed to pass automatically between institutions.

Substance use care extends beyond opioids

Evidence about opioid treatment should not be generalized to every substance use disorder. SAMHSA identifies medications for both opioid and alcohol use disorders, selected according to individual clinical needs. Naloxone reverses opioid overdose; it does not replace ongoing treatment.

For stimulant use disorder, contingency management, which uses structured incentives for agreed treatment goals, is an important approach supported by evidence. A federal evidence review describes it as the most effective treatment currently available for stimulant use disorder. Its implementation requires a properly designed clinical program. A local service map should therefore show which providers offer which kinds of care. A generic list labeled “addiction treatment” cannot tell a resident whether a program can meet their needs.

Build support around the treatment plan

Our recommendation is to connect clinical services with housing assistance, food, transportation, benefits navigation, and voluntary peer support. These services serve different purposes. A peer worker can help someone navigate recovery resources; prescribing and other clinical decisions remain with qualified professionals.

Consider a person offered an appointment across town who has no reliable transport or working phone. Calling that person “unmotivated” would overlook the design of the service. A useful response would ask how to make the appointment reachable and how the person prefers to stay in contact.

Communities should fund that coordination and measure whether it works. Track time to treatment, successful connections, continuity at 30 and 90 days, and barriers reported by participants. Use aggregate reporting and appropriate confidentiality protections. A missed visit should prompt an effort to understand what happened and offer another route into care. The test of a community’s response is whether help remains available after the emergency ends. Treatment, practical support, and continued support should form a path people can use.

Finding care: SAMHSA directs people to FindTreatment.gov to locate services. For a suspected overdose or another immediate medical emergency, call 911.

Selected sources

• National Institute on Drug Abuse, Initiating Buprenorphine Treatment in the Emergency Department
• National Institutes of Health, Treating opioid addiction in jails improves treatment engagement, reduces overdose deaths and reincarceration, September 10, 2025
• SAMHSA, Treatment Options for Substance Use Disorder
• Contingency Management for the Treatment of Substance Use Disorders: Enhancing Access, Quality, and Program Integrity for an Evidence-Based Intervention, Executive Summary