Unlocking the Potential: Medication Assisted Therapies for Opioid Substance Use Disorder in Correctional Settings

It’s no secret the opioid crisis remains a major public health concern in the United States. It was declared a public health emergency in 2017, and for multiple years following, nationwide overdose deaths continued to rise. It wasn’t until 2023 that the country finally saw a downtrend in the number of drug overdoses for the first time since 2018. This was followed by data released in February 2025 that showed the fewest overdose deaths in any 12-month period since 2020. Still, that data shows an estimated 87,000 drug overdose deaths for that year, revealing there is still a lot of work to be done. 

To continue to combat the opioid crisis and continue the decline in overdose deaths, we must consider a population that is highly impacted but rarely discussed – incarcerated individuals. 

U.S. jails admit 6-8 million people annually, many of whom struggle with opioid use disorder. Overdose is also a leading cause of death post-incarceration. Studies show that individuals within the first two weeks post-release are 40% more likely to die from an overdose than the general public. Medication-Assisted Therapy (MAT) programs offer a comprehensive treatment approach to addressing opioid addiction through a combination of FDA-approved medications that stymie cravings for certain drugs and psychological therapeutic strategies, such as cognitive behavioral therapy. 

These programs have proven effective, yet fewer than half of U.S. jails offer jail-based MAT or Medication Opioid Use Disorder (MOUD) treatment, creating a critical care gap and a key opportunity to address a nationwide public health concern. 

The potential of jail-based treatment programs

Jail-based care can reduce the strain on community healthcare systems and help decrease nationwide overdose rates. When a person is admitted to the correctional facility, ideally, they are immediately screened for and enrolled in a MOUD or MAT program before withdrawal symptoms begin. When released, the corrections or facility health staff provide information on where they can go to continue receiving treatment in their community, and they receive a bridge of medications when possible.   

Jail-based treatment decreases the likelihood of an overdose by ensuring patients receive focused care during withdrawal while in the correctional facility, and re-entry support that ensures continuity of care post-release, which is pivotal in reducing recidivism. 

In 2023, 1 in 4 jail admissions was a person returning after a second conviction. MAT and MOUD programs present an opportunity for early intervention when first-time offenders receive treatment, potentially, during the earlier stages of their addiction. The sooner intervention occurs, the lower the risk of developing comorbid health issues like heart disease, liver and kidney problems, and some cancers, which are more prevalent after long-term substance abuse.  

The barriers at play 

As mentioned, despite the fact that two-thirds of people in local jails have substance use disorders, only a fraction of all jails provide MAT and MOUD programs for the incarcerated population. This has to do with lasting stigmas surrounding substance use disorders (SUDs) and lack of access to key medications involved in treatment programs. 

While the National Institute of Health (NIH) classifies addiction as a chronic disease, there are still attitudes to be changed in corrections. Promises to incarcerate illegal drug users dominate public safety-focused political campaigns and stigmatize the incarcerated population suffering from SUDs, leaving little room to garner support for tax-funded MAT and MOUD programs. 

There are only three FDA-approved drugs used in the treatment of SUDs: Buprenorphine, Methadone, and Naltrexone. The government has worked to improve the general population’s access to Buprenorphine in recent years through changes in legislation. However, one study showed that after the DEA waived the requirement for separate registration for clinicians to prescribe buprenorphine, the rate of individuals receiving the drug declined with little to no change in the number of prescribers available. 

Access remains a nuanced issue when you consider that 46% of U.S. counties are pharmacy deserts, meaning more than half of the residents must drive more than 15 minutes to reach a nearby pharmacy. If people struggle to find medications needed to continue treatment in their communities, lack of access to medication impedes the ongoing effectiveness of jail-based programs.

What’s next?

The public health benefits of implementing MAT and MOUD programs into more local jails are evident and worth fighting for. Healthcare providers, especially those behind existing jail-based programs, have a responsibility to advocate for implementing these programs. They must be willing to initiate and participate in difficult conversations with medical peers, business partners, or clients. They must be open to sourcing, and often paying for, qualified specialists to educate reluctant clinicians if necessary, and think creatively about ways to circumvent barriers to access.

Jail-based MAT and MOUD programs are critical for addressing the opioid crisis, but their potential can only be released through increased availability, intentional integration with community-based providers, altered perceptions of SUDs, and improved access to life-saving drugs.

Photo: Jeffrey Hamilton, Getty Images

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