Colorado Jails Still Lack Opioid Treatment Policies Despite Mandate

Nearly 40 percent of Colorado's county jails have no publicly available policy explaining how they treat opioid use disorder, four years after state law ordered every one of them to provide medication treatment and publish those policies, according to a University of Colorado Anschutz study published in the journal Health & Justice.

The review covered all 46 county jails in the state, examining policies collected publicly and directly from facilities between June and October 2024. It amounts to the first systematic audit of the Fentanyl Accountability and Prevention Act, the 2022 law that required county jails to develop and publish opioid treatment policies, offer medications for opioid use disorder to eligible detainees, and connect people to treatment after release. The verdict: legislation alone has not produced the transparency, or the treatment infrastructure, that lawmakers promised.

What the audit found

Among the 28 jails that supplied policy information, the gaps were striking even before considering the 18 that had nothing public at all. Seventy-one percent described screening people for substance use disorder. Sixty-seven percent outlined how they provide medications for opioid use disorder. Sixty-three percent addressed connecting people to treatment after release — the period when overdose risk spikes most dangerously.

Fewer than half, 46 percent, indicated they offered all three FDA-approved medications: methadone, buprenorphine, and extended-release naltrexone. Just 26 percent included peer recovery support services, and only 22 percent described harm-reduction measures such as handing out naloxone at the gate.

"State legislation is an important first step, but policies also need to be transparent, comprehensive and consistently implemented," said Katherine LeMasters, PhD, MPH, senior author of the study and assistant professor of medicine at CU Anschutz and the Colorado School of Public Health. "Publicly available policies can help healthcare providers, families and community organizations better support people during incarceration and after they're released."

A line between urban and rural

The divide between Colorado's urban counties and its rural ones runs through nearly every finding. Urban jails were generally more likely to maintain comprehensive policies covering screening, treatment, and post-release care. Rural jails often faced limited access to opioid treatment programs and other community resources — a structural barrier no mandate can erase by itself.

"Some jails want to offer these medications but face significant barriers," LeMasters said. "Methadone, for example, must be dispensed through federally regulated and state-licensed opioid treatment programs, which can make access especially difficult in rural areas. Sustainable funding, technical assistance and partnerships with community providers will be essential to fully implement the law."

Without medication, people in custody endure withdrawal that is both brutal and counterproductive. "When these medications aren't available, people may go through painful withdrawal while they're in custody," LeMasters said. "After release, that can increase the risk of returning to opioid use, overdose and death."

Paper policies, real lives

The researchers acknowledged a central limitation: the study evaluated written policies rather than clinical practice, so some jails may deliver care their documents don't reflect. But they argue transparency is itself a form of infrastructure — it enables continuity of care, lets families and providers know what to expect, and shows where resources are missing.

The Colorado findings land against a national backdrop that offers little comfort. A survey published earlier this year found that only 58 percent of U.S. correctional facilities offer any form of medication for opioid use disorder, leaving nearly half of the incarcerated population without access to the gold-standard treatment even as post-release overdose deaths run dozens of times higher than in the general population.

As more states weigh mandates of their own, LeMasters and her co-authors — including Paul Christine, MD, PhD; Jarratt Pytell, MD; and Ingrid Binswanger, MD, of CU Anschutz — present Colorado as both a proof of concept and a caution. Passing a law changed what jails are required to do. It did not, by itself, change what many of them actually do.

"This is ultimately about saving lives," LeMasters said. "Jails are an important place to reach people with opioid use disorder, but they shouldn't be the only place. Expanding access to treatment in communities before people enter the criminal justice system remains just as important."