National Survey Reveals Only 58% of Correctional Facilities Offer Life-Saving Opioid Medications

A new cross-sectional survey published in the Journal of Correctional Health Care has revealed what addiction medicine experts have long suspected but struggled to quantify: the vast majority of people cycling through American jails and prisons—populations with some of the highest rates of opioid use disorder in the country—have no access to the medications proven to cut overdose risk and save lives.

The findings, released March 17, 2026 by Indivior Pharmaceuticals in partnership with the National Commission on Correctional Health Care (NCCHC), paint a sobering picture of treatment infrastructure behind bars. Of 212 correctional facilities surveyed—jails, prisons, and detention centers across the United States—just 58% offer at least one FDA-approved medication for opioid use disorder (MOUD). That leaves nearly half of the nation's incarcerated population without access to what the National Academies of Sciences, Engineering, and Medicine have called the "gold standard" treatment for opioid addiction.

The stakes could hardly be higher. An estimated 17% of individuals in state prisons and 19% of those in jails meet diagnostic criteria for opioid use disorder. Research shows that people in their first two weeks following release from incarceration face overdose mortality rates up to 40 times higher than the national average—a window so deadly that researchers call it the "reentry crisis." MOUD during incarceration can significantly reduce these risks, yet the survey suggests access remains more exception than rule.

Jails Lead, Prisons Lag

One of the survey's most striking findings involves the gap between jails and prisons. Jails—facilities typically holding individuals awaiting trial or serving sentences of less than a year—were more than twice as likely to provide MOUD compared to state or federal prisons. That disparity reflects both policy differences and the different missions of these institutions. Jails, often run by counties, have increasingly embraced harm reduction principles and medication treatment under pressure from local public health agencies, sheriffs who've watched overdose deaths spike, and communities demanding alternatives to the revolving door of arrest-release-overdose.

Prisons, by contrast, operate under state or federal systems that have been slower to adopt medication treatment. Many state correctional departments still adhere to abstinence-only philosophies, treating medications like buprenorphine and methadone as "substituting one addiction for another"—a view categorically rejected by the medical establishment but one that persists in institutional cultures shaped more by punishment than public health.

Dr. Christian Heidbreder, Chief Scientific Officer at Indivior, framed the findings in stark terms: "This study reinforces the urgent need to integrate evidence-based care into jails and prisons. 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."

Geography as Destiny

Regional disparities proved equally pronounced. Facilities in the West had over three-fold higher odds of offering MOUD than those in the Midwest. The South reported the lowest rates of treatment access, with fewer than 10% of diagnosed individuals receiving medication—a figure that aligns with the region's broader struggles with healthcare infrastructure, Medicaid expansion resistance, and political skepticism toward harm reduction approaches.

Midwest facilities reported moderate levels of treatment for diagnosed individuals, though "moderate" in this context meant anywhere from below 10% to between 20%–29%—hardly a comfort when the evidence shows MOUD can cut overdose mortality by 50% or more. The West's higher rates reflect both more progressive state policies and proximity to harm reduction networks that have advocated for medication access in correctional settings since the early 2000s.

Rural areas, regardless of region, face compounding challenges. Many correctional facilities in remote counties lack the healthcare infrastructure to administer daily medications, let alone coordinate with community providers for post-release continuity of care. The survey found that rural facilities report the greatest uncertainty about care delivery—a polite way of saying they often don't know where to start, don't have budget for trained staff, and can't reliably source the medications even when they want to.

What Correctional Health Staff Say They Need

Beyond the numbers, the survey captured qualitative feedback from correctional health professionals about what would actually make a difference. Their responses converged on five themes, none of which can be addressed by goodwill alone.

First, respondents called for greater investment in long-acting injectable formulations—medications like extended-release buprenorphine and extended-release naltrexone that eliminate the daily pill-taking ritual and the diversion concerns that make some administrators nervous. Injectable formulations also simplify pre-release planning: a single injection before discharge can provide coverage while the individual navigates the chaos of reentry, buying time to connect with community-based treatment.

Second, telehealth partnerships emerged as critical, particularly for rural facilities where recruiting addiction medicine specialists is nearly impossible. Telemedicine can bring prescribers into facilities that would otherwise have none, but implementation requires reliable internet infrastructure, regulatory clarity around cross-state licensure, and Medicaid reimbursement that actually covers virtual visits from correctional settings—obstacles that remain unresolved in many states.

Third, respondents emphasized pre-release planning and warm handoffs—the difference between releasing someone with a printed list of phone numbers and releasing someone with an appointment already scheduled, a week's supply of medication, and a peer navigator waiting at the gate. The latter approach, sometimes called "bridge dosing," has shown dramatic improvements in post-release engagement, but it requires coordination between corrections, community health centers, and insurers—systems that rarely communicate well even when lives are at stake.

Fourth, housing and employment support featured prominently. Medication keeps someone alive, but stability keeps them engaged. Respondents highlighted the role of transitional housing, job training, and financial support in sustaining recovery—interventions that fall outside traditional medical budgets but that correctional health staff recognize as inseparable from treatment success.

Finally, respondents pointed to comprehensive medical homes that combine MOUD with mental health care, infectious disease treatment (many people entering corrections carry untreated hepatitis C or HIV), and social support. The fragmented model—send this person to the methadone clinic on Third Street, that counselor across town, HIV care at the county hospital—fails people whose lives are already precarious. Integration isn't a luxury; it's a prerequisite for retention.

Barriers That Money Alone Can't Fix

Despite growing recognition that MOUD represents the standard of care for opioid use disorder, many facilities cited persistent barriers to implementation. Stigma ranked high. Correctional officers who view addiction as moral failure resist policies that "coddle" inmates with medication. Administrators worry about diversion—people selling pills inside facilities—even though research shows diversion risks are manageable and far outweighed by the benefits of treatment.

Abstinence-only philosophies remain entrenched in some systems, particularly those influenced by therapeutic community models that treat medication as antithetical to "real" recovery. These philosophies ignore decades of evidence but retain institutional momentum, defended by staff who came of age in the "just say no" era and who see medication as capitulation.

Lack of provider training compounds the problem. Many correctional physicians have no addiction medicine training and feel uncomfortable prescribing buprenorphine or coordinating methadone treatment. Facilities that want to expand MOUD often discover they have nowhere to send staff for training, no one locally who can mentor new prescribers, and no time to spare from the daily grind of managing chronic disease and acute crises in chronically understaffed health units.

Limited budgets loom over everything. Medications cost money. Staff time costs money. Coordination with external providers costs money. States that underfund correctional healthcare as a matter of course—and most do—leave administrators choosing between MOUD and other pressing needs like cancer treatment, dialysis, or just keeping the lights on in the infirmary. Federal grants and opioid settlement dollars have helped, but those funds are often restricted, time-limited, or contingent on political winds that shift with elections.

The Road Forward

Vanessa Procter, Executive Vice President of Corporate Affairs at Indivior, noted the convergence of crisis and opportunity: "With renewed national attention on strengthening addiction treatment and recovery, our study underscores both the opportunities and the challenges ahead. 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. Improving continuity of care—from incarceration to community—is not a partisan issue. It's a public health imperative, and the evidence shows what works."

Whether that optimism proves warranted depends on actions, not intentions. Opioid settlement funds represent a once-in-a-generation infusion of resources—over $50 billion nationally—but those dollars will disappear into general budgets, administrative overhead, and programs with tenuous connections to treatment unless advocates and policymakers insist on accountability. Several states have already begun pilot programs using settlement money to expand MOUD in corrections, fund reentry coordinators, and establish transitional housing specifically for people leaving jail or prison with opioid use disorder.

The federal government, too, has begun to move. The Department of Justice's Bureau of Justice Assistance has made MOUD in corrections a funding priority, and the Centers for Medicare & Medicaid Services has clarified that Medicaid coverage can be "suspended" rather than "terminated" during incarceration, allowing immediate reactivation upon release—a bureaucratic shift that can mean the difference between having insurance on day one or waiting weeks for approval.

But policy changes mean little if they don't reach the 212 facilities surveyed—and the thousands more that weren't. The 42% of correctional facilities offering no MOUD at all represent a population measured in hundreds of thousands of individuals cycling through the justice system each year, many of whom will leave custody and overdose within weeks because they never had access to the treatment that could have saved them.

The survey's findings do more than document gaps; they quantify the cost of inaction. Every facility that refuses MOUD on ideological grounds, every state that underfunds correctional healthcare to the point where treatment becomes impossible, every administrator who cites "security concerns" without evidence—these aren't abstract policy failures. They're death sentences handed down in increments, executed not in chambers but on street corners and in apartments and homeless encampments where people released from custody without medication, without housing, without hope, use alone and don't wake up.

Fifty-eight percent is better than zero. It's also 42 percentage points short of what evidence, ethics, and the sheer scale of preventable death demand.