Less Than 60% of U.S. Correctional Facilities Offer Opioid Treatment, National Survey Reveals

A national survey published Monday in the Journal of Correctional Health Care reveals that fewer than six in ten U.S. correctional facilities offer any FDA-approved medication for opioid use disorder, leaving thousands of incarcerated individuals without access to treatments proven to cut overdose deaths by more than half.

The cross-sectional study, conducted by pharmaceutical company Indivior in partnership with the National Commission on Correctional Health Care, surveyed 212 jails, prisons, and detention centers across the country. Just 58% reported offering at least one medication for opioid use disorder—buprenorphine, methadone, or naltrexone—despite growing scientific consensus that these treatments are the standard of care for OUD.

The findings land as overdose deaths among recently released inmates remain a persistent blind spot in the nation's addiction crisis. Research cited in the survey shows that individuals in their first two weeks post-release face overdose mortality rates up to 40 times higher than the national average. MOUD treatment during incarceration can significantly reduce these risks and improve treatment retention after release.

Jails Outpace Prisons, But Regional Gaps Persist

The survey uncovered sharp disparities by facility type and geography. Jails were more than twice as likely to provide MOUD compared to state and federal prisons, and facilities in the West had over three-fold higher odds of offering treatment than those in the Midwest.

Regional variation runs deeper than access alone. In the South, fewer than 10% of diagnosed individuals receive treatment in many facilities. Midwest institutions report moderate levels—some below 10%, others reaching 20–29%. The South, Midwest, and rural areas reported the greatest uncertainty about care delivery and infrastructure to support MOUD programs.

An estimated 17% of individuals in state prisons and 19% of those in jails meet the criteria for opioid use disorder. With more than two million people cycling through U.S. correctional facilities annually, the treatment gap translates to hundreds of thousands of individuals leaving incarceration without medication that could prevent fatal overdose.

"This study reinforces the urgent need to integrate evidence-based care into jails and prisons," said Dr. Christian Heidbreder, Chief Scientific Officer at Indivior. "To truly address the opioid crisis, we must ensure continuity of care, expand access to medications for opioid use disorder, and eliminate the stigma that prevents people from receiving treatment during and after incarceration."

What Correctional Health Professionals Say They Need

Beyond the quantitative findings, the survey captured qualitative feedback from health care staff working inside jails and prisons. Respondents identified five critical areas for improving MOUD access and sustaining recovery after release:

Long-acting injectables and telehealth
Staff called for greater investment in cost-effective medications, including funding for extended-release buprenorphine and extended-release naltrexone. Telemedicine partnerships were highlighted as essential for extending care into rural settings where provider shortages are acute.

Continuity of care and transition services
Respondents emphasized pre-release planning and "warm handoffs" from incarceration to community-based MOUD providers. The abrupt cutoff of medication at release—common in facilities that do offer treatment—undermines its protective effect during the highest-risk window.

Housing and employment
Transitional housing, job training, and financial stability were identified as foundational to sustaining recovery. Without stable housing, formerly incarcerated individuals often cycle back into environments where substance use is prevalent.

Comprehensive treatment approaches
Staff advocated for "medical homes" that integrate MOUD with mental health care, infectious disease treatment, and social support. Co-occurring disorders are common among incarcerated populations, and fragmented care leaves many needs unmet.

Community support networks
Peer mentorship, recovery organizations, and community-based programs were noted as critical for engagement post-release and reducing reincarceration.

Barriers Rooted in Stigma and Infrastructure

Despite growing recognition of MOUD as evidence-based care, many facilities cited persistent obstacles to implementation. Stigma and abstinence-only philosophies remain entrenched in some correctional systems, where medication-assisted treatment is still viewed as "replacing one drug with another" rather than managing a chronic medical condition.

Lack of provider training, limited budgets, and geographic disparities in healthcare infrastructure compound the problem. In rural counties, where many jails operate with minimal medical staff, finding physicians trained in addiction medicine—or willing to prescribe buprenorphine or methadone—can be nearly impossible.

Regulatory and logistical challenges also play a role. Methadone, the most studied MOUD, requires dispensing through federally certified opioid treatment programs, complicating its use in correctional settings. Buprenorphine, which can be prescribed by any DEA-licensed physician since the 2023 elimination of the X-waiver, offers more flexibility but still requires buy-in from corrections administrators and clinical staff.

Extended-release injectable formulations of buprenorphine and naltrexone address some adherence and diversion concerns, but their higher upfront costs can deter cash-strapped facilities—even as studies show they reduce downstream healthcare spending by preventing emergency department visits and overdoses.

Policy Momentum Meets Implementation Gaps

The survey arrives as federal policy shifts toward expanding Medicaid coverage in correctional settings. A recent New York Times report highlighted how states are beginning to use Medicaid funds to pay for health care in jails and prisons, smoothing inmates' transition to community-based care and enabling MOUD access that previously fell outside reimbursement structures.

"With renewed national attention on strengthening addiction treatment and recovery, our study underscores both the opportunities and the challenges ahead," said Vanessa Procter, Executive Vice President of Corporate Affairs at Indivior. "We're encouraged to see recovery rising on the federal agenda, and these data offer a roadmap for expanding life-saving care inside jails and prisons."

Procter framed continuity of care—from incarceration to community—as "not a partisan issue" but "a public health imperative." The evidence supports that framing: MOUD has been shown to reduce all-cause mortality among individuals with OUD by 50% or more, with the greatest benefit during the vulnerable re-entry period.

Yet implementation lags behind rhetoric. The South's single-digit treatment rates and the Midwest's infrastructure gaps reflect deeper structural issues—underfunded public health systems, rural provider deserts, and correctional cultures resistant to harm reduction philosophies.

A Critical Intervention Point

Correctional facilities represent one of the most concentrated opportunities to reach individuals with opioid use disorder. Unlike community-based treatment, which requires individuals to navigate insurance, transportation, and waitlists, incarceration creates a forced pause—a captive population with daily medical access.

The question is whether that access translates to evidence-based care. The survey suggests that for nearly half of U.S. facilities, it does not.

As the overdose crisis evolves—fentanyl-involved deaths declining modestly even as polysubstance fatalities rise—the role of correctional settings becomes more urgent. Inmates cycling through jails in high-overdose counties often have histories of multiple overdoses, emergency department visits, and previous treatment attempts. They are precisely the population most likely to benefit from MOUD.

The survey's findings point to a clear path forward: expand access to long-acting injectables, fund telehealth partnerships for rural facilities, train correctional health staff in addiction medicine, and build robust reentry systems that connect individuals to housing, employment, and community-based care.

Whether policymakers and corrections administrators will act on that roadmap—or whether the 42% of facilities without MOUD will remain treatment deserts—will shape overdose mortality trends for years to come. In the two weeks after release, the window for intervention is measured in days. For tens of thousands of individuals leaving U.S. jails and prisons this year, the availability of medication could mean the difference between life and death.