Mechanism Design for Harm Reduction in Multi‑Principal Carceral MOUD and Recovery Housing

Mechanism Design for Harm Reduction in Multi‑Principal Carceral MOUD and Recovery Housing | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Perspective Mechanism Design for Harm Reduction in Multi‑Principal Carceral MOUD and Recovery Housing Tarnell Brown This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9442500/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Individuals leaving jail and prison face exceptionally high risks of fatal overdose and rapid reincarceration, yet many jurisdictions continue to underutilize diversion, medications for opioid use disorder (MOUD), and recovery housing despite strong evidence of effectiveness. This paper argues that the persistence of punitive drug policy is best understood as an institutional coordination problem rather than a clinical or evidentiary failure. Courts, correctional agencies, housing providers, and funders operate under fragmented budgets, asymmetric political accountability, and misaligned incentives that can make restrictive practices individually rational even when harm-reduction regimes are socially superior. To clarify these dynamics, the paper develops a multi-principal institutional model linking diversion, carceral MOUD, and recovery housing decisions. Calibrated to evidence from Rhode Island’s statewide MOUD program, Massachusetts’ jail-based expansion, and recovery housing evaluations, the analysis shows that harm-reduction regimes are often empirically and fiscally dominant yet fail to emerge because punitive practices are risk-dominant for individual institutions. The paper then identifies implementable policy levers—funding alignment, performance transparency, and default rules—that can shift equilibrium selection within existing constitutional and statutory constraints. By reframing overdose prevention as an institutional design problem, the analysis offers concrete tools for policymakers seeking to reduce avoidable lethal risk without requiring wholesale legal transformation. JEL Codes: I12, I18, D82, K42 opioid use disorder medications for opioid use disorder (MOUD) correctional health recovery housing harm reduction institutional incentives overdose prevention Full Text Additional Declarations No competing interests reported. Supplementary Files AppendixA.docx AppendixB.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 11 May, 2026 Reviewers agreed at journal 09 May, 2026 Reviewers invited by journal 27 Apr, 2026 Editor assigned by journal 27 Apr, 2026 Editor invited by journal 23 Apr, 2026 Submission checks completed at journal 22 Apr, 2026 First submitted to journal 22 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9442500","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Perspective","associatedPublications":[],"authors":[{"id":632628091,"identity":"0c6e8faf-477d-41b0-b27f-f6ab24cc8d67","order_by":0,"name":"Tarnell Brown","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYDACCTBpU9/PztgGEzPAq4MHoiWNcWYzWIsB0VoOM244zMBGnBZ76d6Hj3l3MDMbH2Zue/Bxz5/EBvbmbRJ4bZE5bmzMe4aNzewwY7vhjGcGiQ08x8rwa5FIY5PObePhAWppk+Y5ANQikWNGjBYJCWOg96X/gLTIvyFKi4GBATNQCwPYFh4CWu4cYzb+25aQIAHyS88BY+M2nrRiC3xa2Ge3MT6c2fY/gb+9/dmDHwfkZPvZD2+8gU8LBnBsI6wGDdiTrGMUjIJRMAqGPQAA4GNCunkpy4kAAAAASUVORK5CYII=","orcid":"","institution":"Independent Scholar","correspondingAuthor":true,"prefix":"","firstName":"Tarnell","middleName":"","lastName":"Brown","suffix":""}],"badges":[],"createdAt":"2026-04-16 23:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9442500/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9442500/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108805117,"identity":"ff671eb9-bd87-41fc-87f0-592b3c36edad","added_by":"auto","created_at":"2026-05-08 15:24:53","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":436331,"visible":true,"origin":"","legend":"","description":"","filename":"DiscoverManuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9442500/v1_covered_95cc0185-ec64-4abb-9a78-30e983d605c1.pdf"},{"id":108549873,"identity":"22cd3482-ba64-417f-a1f3-f724fa27368c","added_by":"auto","created_at":"2026-05-05 22:26:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":37356,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-9442500/v1/cfa99539247ae9326da9e607.docx"},{"id":108549872,"identity":"d587fe06-e8d6-4dc9-a4e4-048377b8b48e","added_by":"auto","created_at":"2026-05-05 22:26:36","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25311,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixB.docx","url":"https://assets-eu.researchsquare.com/files/rs-9442500/v1/be9c5daece9920c59bf5104e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mechanism Design for Harm Reduction in Multi‑Principal Carceral MOUD and Recovery Housing","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-social-science-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diss","sideBox":"Learn more about [Discover Social Science and Health](https://www.springer.com/journal/44155)","snPcode":"","submissionUrl":"","title":"Discover Social Science and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"opioid use disorder, medications for opioid use disorder (MOUD), correctional health, recovery housing, harm reduction, institutional incentives, overdose prevention","lastPublishedDoi":"10.21203/rs.3.rs-9442500/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9442500/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIndividuals leaving jail and prison face exceptionally high risks of fatal overdose and rapid reincarceration, yet many jurisdictions continue to underutilize diversion, medications for opioid use disorder (MOUD), and recovery housing despite strong evidence of effectiveness. This paper argues that the persistence of punitive drug policy is best understood as an institutional coordination problem rather than a clinical or evidentiary failure. Courts, correctional agencies, housing providers, and funders operate under fragmented budgets, asymmetric political accountability, and misaligned incentives that can make restrictive practices individually rational even when harm-reduction regimes are socially superior.\u003c/p\u003e\n\u003cp\u003eTo clarify these dynamics, the paper develops a multi-principal institutional model linking diversion, carceral MOUD, and recovery housing decisions. Calibrated to evidence from Rhode Island’s statewide MOUD program, Massachusetts’ jail-based expansion, and recovery housing evaluations, the analysis shows that harm-reduction regimes are often empirically and fiscally dominant yet fail to emerge because punitive practices are risk-dominant for individual institutions. 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