Only 14% of U.S. Jails Publicly Confirm They Treat Opioid Addiction

Just 396 of the 2,920 U.S. jails — 13.6 percent — had any public record confirming that they offer medications for opioid use disorder, according to a research letter led by Brown University and published November 3 in JAMA Network Open. Prisons did better but still fell short: 25.6 percent of 1,746 facilities published evidence of a medication program.

The gap the authors describe is not proof that the other 86 percent of jails withhold treatment. It is proof that most correctional facilities say nothing at all about whether they treat addiction — and that families, public defenders and discharging patients have no reliable way to find out before release.

What the researchers counted

The team, drawn from Brown, Rice University's Rice360 Institute for Global Health Technologies, Duke University and UMass Chan Medical School, assembled a facility list from 2020 census data and Bureau of Justice Statistics records. Beginning in 2022, researchers searched state government websites, county sheriff's office pages and news reports for evidence that a jail or prison provided methadone, buprenorphine or naltrexone. The dataset reflects what was publicly available as of April 1, 2025.

Among facilities that did publish something, the details diverged sharply. About 55.5 percent of prisons said they offered all three medications, compared with 16.9 percent of jails. One-third of jails with a public record listed naltrexone only — the medication that requires a patient to be free of opioids for roughly a week before the first dose, a difficult condition for someone arriving in custody physically dependent. Another 27.5 percent of jails with a record did not name which medication they used at all.

Methadone or buprenorphine, the two agonists that ease cravings and withdrawal, were available at 72.9 percent of prisons with a record but only 39.1 percent of jails. Not a single facility in the dataset publicly stated that it does not offer treatment.

"Most US correctional facilities provide no publicly available data on MOUD at all," the authors wrote, concluding that "uniform public reporting standards for MOUD provision in US correctional facilities are urgently needed."

Why the silence is a clinical problem

Roughly two-thirds of people in U.S. jails have a substance use disorder, according to a 2024 NIDA release. Many arrive taking buprenorphine or methadone and lose access to it at booking. During a short stay without treatment, tolerance falls; people who return to their previous dose after release are at elevated risk of a fatal overdose. NIDA notes that many resume "the amounts they used before, not realizing their bodies can no longer tolerate the same doses."

The weeks after release are the danger window. A CDC resource for correctional facilities identifies the post-release period as a common time for fatal overdose, especially from opioids, and notes that providing buprenorphine or methadone at release is associated with fewer overdose deaths in the following weeks.

Rhode Island is the clearest counterexample in the record. Its Department of Corrections began offering all three medications statewide in 2016; a study of 1,600 people released between December 2016 and December 2018 counted 12 overdose deaths in the year after release, only one of them in the first two weeks. That program is also where the study's first author learned the problem from the inside: Dr. Justin Berk directs Brown University Health's Center for Health and Justice Transformation and previously served as medical director of the Rhode Island Department of Corrections.

What the numbers cannot show

The authors are explicit about the limits. The review relied only on public information, so jails that run programs without posting about them would be counted as silent — which is why the authors describe their estimates as likely lower bounds. The figures count facilities, not people, and say nothing about how many incarcerated patients actually receive medication. A one-time review also cannot capture policy changes made after April 2025.

The study was funded by the National Institutes of Health, including NIDA. The journal's disclosures note that Berk has provided paid medical expert testimony on correctional health care.

Where this leaves families and discharge planning

The practical consequence is that the information gap falls on people with the least leverage to close it. A parent trying to arrange continuing care for a son leaving county jail, or a public defender arguing for a treatment condition at sentencing, is often working from nothing more than a phone call to a facility's medical unit.

The study's authors call for uniform public reporting standards for MOUD in correctional facilities — a measure that would let researchers, families and discharge planners see whether the opioid treatment programs that do operate behind bars are reaching the patients who need them.

For families, the concrete questions are whether a facility continues methadone or buprenorphine for someone already in treatment, whether it can start medication, and what happens on release day. Asking for a referral to a community clinic and a supply of medication at discharge addresses the gap the data describes. Households can also keep naloxone on hand — naloxone reverses an opioid overdose — and call 911 if someone is unresponsive or breathing has slowed. Free treatment referrals are available around the clock through the SAMHSA National Helpline at 1-800-662-4357.

The related problem of paying for care after release is already moving: Washington is one of 22 states with a federal waiver letting Medicaid pay for reentry work, and King County's two jails now bill for release planning for nearly all 1,400 people in custody.