Missouri Prisons Face Federal Lawsuit Over Systematic Denial of Opioid Treatment

Bradley Ketcherside knew he was running out of time.

After multiple overdoses at Crossroads Correctional Center in Cameron, Missouri, the incarcerated man filed his third application for medication-assisted treatment in January 2025. In a brief evaluation that lasted less than 15 minutes, he told mental health staff that buprenorphine "would save my life," according to prison medical records.

The evaluator denied his request, concluding Ketcherside didn't show severe enough signs of addiction. Six days later, staff found him cold and unresponsive in his cell. Efforts to administer naloxone were unsuccessful.

A Pattern of Denial

On March 5, 2026, attorneys with the civil rights law firm Khazaeli Wyrsch filed a federal lawsuit on behalf of Ketcherside's widow, alleging his death was not an isolated tragedy but evidence of systematic failures by the Missouri Department of Corrections and its healthcare contractor, Centurion Health.

The complaint argues that Missouri prison officials "systemically deny and unreasonably delay necessary medical care to inmates diagnosed with opioid use disorder," discriminating against them under the Americans with Disabilities Act and placing them at unnecessary risk of death.

"The stakes are life and death," said Leah Fessler, lead attorney on the case. "It is a huge injustice to allow people to die in prison from the condition that put them in prison without offering them any access to proper medical treatment."

The lawsuit comes as Missouri's prison population diagnosed with opioid use disorder has exploded from roughly 1,500 in 2024 to nearly 7,000 in 2025 — a spike the Department of Corrections attributes in part to improved screening tools. Yet only 3,700 incarcerated people are currently receiving medication-assisted treatment, leaving more than half of those diagnosed without access to evidence-based care.

The Bureaucratic Maze

Prison records and letters from incarcerated people reveal a labyrinth of arbitrary barriers to treatment. Ketcherside was denied twice because he wasn't close enough to his release date. On his final attempt, evaluators said he didn't meet criteria because he hadn't used opiates since his last overdose months earlier — a paradoxical standard that punishes sobriety while simultaneously denying care to those actively using.

Other incarcerated individuals described being told they couldn't receive treatment because they weren't "actively overdosing" or "in withdrawal" at the moment of evaluation. One man recalled a medical provider saying, "We can't do nothing for you until you overdose again."

Brandon Church, a 34-year-old at Jefferson City Correctional Center, experienced the other side of that cruel equation. After being placed in solitary confinement, he was taken off his opioid use disorder medication. In a January 2025 letter to Fessler, he described how the medication had made him "feel normal" for the first time and eliminated his cravings.

"I would really like to make it home," Church wrote. Two weeks later, prison staff found him hanging by his neck in his cell.

Drugs Flow In, Treatment Doesn't Flow Out

The lawsuit paints a picture of a prison system flooded with illicit substances — often smuggled in by staff themselves — while simultaneously erecting insurmountable obstacles to medical treatment.

At Crossroads, where Ketcherside died, the main entrance had no overnight security for months at a time, the complaint alleges. Corrections officers and medical staff exploited this gap to profit from people with substance use disorders by illegally bringing drugs into the facility and selling them.

Multiple corrections officers in Missouri were charged last year with drug trafficking. Yet rather than addressing the supply side, the department has responded to substance use with punishment: solitary confinement, loss of wages, extended sentences, and disqualification from rehabilitation programs under Rule 11 violations.

"My drug use resulted in violations that resulted in extending my stay," one incarcerated person wrote in a letter to attorneys. "MODOC has refused to help me and continued to punish me for my substance abuse, addiction, and mental health conditions."

The Profit Motive Behind Denial

Experts point to the role of private healthcare contractors like Centurion Health in creating systemic barriers to treatment. These companies operate on profit margins rather than patient outcomes, creating financial incentives to minimize medication costs.

"The less medication they prescribe, the more money they save in their contract, the more profit they make their investors," said Dr. Fred Rottnek, a professor at St. Louis University School of Medicine who consults on substance use treatment access in prisons.

Missouri has nearly $7 million from opioid settlement funds earmarked for expanding medication-assisted treatment this fiscal year — money obtained through lawsuits against the very pharmaceutical companies that fueled the crisis. Yet the gap between funding and implementation remains vast.

In its budget request for fiscal year 2026, the Department of Corrections estimated treatment costs between $6,500 and $14,200 per person annually. Officials projected scaling the MAT program from 121 people in 2024 to 841 by summer 2026 — a target that has been surpassed on paper but clearly not in practice, given that over 3,000 diagnosed individuals remain untreated.

Medical Consensus Ignored

The National Commission on Correctional Health Care and decades of research support three medications for opioid use disorder: buprenorphine and methadone, which bind to opioid receptors to reduce cravings, and naltrexone, which blocks receptors but doesn't address underlying addiction mechanisms.

"Buprenorphine and methadone have decades of data showing their efficacy, and naltrexone does not meet that standard," said Melissa Stein, a consultant who worked with Missouri DOC to develop its MAT program.

Yet incarcerated people report being placed on naltrexone against their wishes and forced to demonstrate negative side effects before being allowed to try more effective medications — an approach Stein said "is not in accordance with medical best practice."

The lawsuit also highlights how placement in solitary confinement triggers forced withdrawal, which can be a medical emergency leading to suicide or self-harm. Missouri's practice of removing people from medication when they enter restrictive housing directly contradicts medical guidance.

A Rare Success Story

The complaint contrasts these failures with the case of Colby Rey, who has been incarcerated in Missouri since 2022. After two years of denied requests and three overdoses that sent him to solitary, Rey finally obtained buprenorphine treatment — but only after working with attorneys to draft a legal demand letter.

His experience on medication has been transformative, demonstrating what could happen if the barriers were removed for the thousands of others in similar circumstances.

What the Lawsuit Demands

In addition to monetary relief for Ketcherside's widow and the children he helped raise, the suit calls for systemic reforms to ensure incarcerated people receive constitutionally adequate medical care for opioid use disorder.

ACLU Staff Attorney Joseph Longley called the arbitrary denials both unconstitutional and disability discrimination: "There's really no excuse, and them not providing it anyway is such a clear example of deliberate indifference to the medical needs of people with opioid use disorder."

The Department of Corrections declined to comment on specific allegations but stated in an email that "any incarcerated person with an opioid disorder has access to institutional treatment programs" and can be prescribed medication-assisted treatment "if approved by their medical provider."

That qualification — "if approved" — is precisely what the lawsuit challenges.

Angela Ketcherside, Bradley's widow, is hoping the case will force reforms that prevent other families from experiencing the same loss.

"It all comes down to the fact that he was their responsibility," she said. "And if they had done their job properly, he'd still be here."

The lawsuit names both the Missouri Department of Corrections and Centurion Health as defendants, seeking to hold them accountable for what attorneys describe as a pattern of deliberate indifference that turns incarceration into a death sentence for people struggling with addiction.

As the case moves forward, it will test whether courts are willing to enforce the constitutional right to medical care in an environment where drugs flow freely but treatment remains locked away.