Insights: Treating Addiction to Opioids in a Criminal Justice Setting: NIH Policy Brief

Treating Opioid Addiction in Jails and Prisons

About 65 percent of the U.S. prison population has an active substance use disorder, and only 5 percent of people with opioid use disorder in jails and prisons receive medication treatment, according to NIDA’s criminal justice research. Those two numbers next to each other are the entire policy problem.

Release is the dangerous moment, and housing is what meets it or does not. Someone leaving custody into the same street they left has a matter of days before the risk peaks, which is why sober homes in Massachusetts and every other state page in this directory matter to a reentry plan rather than to an abstract debate.

Why Medication Is the Treatment That Works

Medications for opioid use disorder are the most effective treatment available. Three are used: buprenorphine, methadone, and extended-release naltrexone.

Delivered during incarceration, they:

• Reduce opioid use and relapse
• Lower the risk of fatal overdose
• Improve retention in treatment after release
• Reduce transmission of HIV and hepatitis C
• Reduce drug-related criminal activity
• Support reintegration rather than complicating it

They work best alongside behavioural counselling and recovery support. Detox on its own, with no follow-up and nowhere stable to go, rarely produces lasting sobriety, and in a correctional setting it produces something worse.

The Weeks After Release Are the Deadliest

Tolerance falls during incarceration and does not announce it. Someone who returns to a previous dose after release is taking a quantity their body can no longer handle. NIDA reports that 14.8 percent of all former prisoner deaths between 1999 and 2009 were opioid-related.

Starting medication inside changes what happens outside. People who begin methadone or buprenorphine while incarcerated are considerably more likely to stay in treatment after release, and continuity of care is the variable that carries the effect.

Forced withdrawal on entry to custody works directly against this, and it is not only a clinical question. Department of Justice guidance on the ADA and opioid use disorder is explicit that people taking legally prescribed medication for opioid use disorder are protected from discrimination.

Why Only 5 Percent Receive It

Availability is the constraint rather than evidence. NIDA reported in 2024 that fewer than half of U.S. jails provide medications for opioid use disorder, and the National Academy of Sciences has found that many prison medical directors are unaware of the benefits. Where treatment is offered at all, it is often counselling or detox without ongoing medication.

Stigma does real work here too. Addiction is judged more harshly than mental illness on every measured dimension), and a population that is both incarcerated and using drugs sits at the bottom of public sympathy. That shapes what gets funded.

What Release Planning Should Include

Treatment started inside needs somewhere to continue. A recovery residence is housing rather than treatment, which is precisely why it pairs with medication rather than competing with it: the house supplies the address, the routine, and the accountability while the clinical care continues elsewhere.

• Medication continued without interruption on the day of release
• A confirmed bed rather than a list of phone numbers
• A home that accepts residents on medication for opioid use disorder
• A first appointment already booked
• Someone to call in the first week

That third point is worth asking about explicitly. Some homes still refuse residents on methadone or buprenorphine, which is both clinically wrong and, where it amounts to disability discrimination, legally exposed.

Frequently Asked Questions

How many incarcerated people have a substance use disorder?

About 65 percent of the U.S. prison population has an active substance use disorder, according to NIDA. A further 20 percent were under the influence of drugs or alcohol at the time of their offence, bringing the combined figure to roughly 85 percent.

Can you get methadone or buprenorphine in jail?

Sometimes, and far less often than you would expect. NIDA reported in 2024 that fewer than half of U.S. jails provide medications for opioid use disorder, and only about 5 percent of incarcerated people with opioid use disorder receive medication treatment.

Why is overdose risk so high right after release?

Tolerance drops during incarceration. Someone who returns to their previous dose after release is taking an amount their body can no longer handle. NIDA reports that 14.8 percent of former prisoner deaths between 1999 and 2009 were opioid-related.

Can a sober living home refuse someone on medication?

Some do, and it is a question to ask before accepting a bed. Department of Justice guidance states that people in treatment or recovery, including those on legally prescribed medication, are protected from discrimination under the ADA.

What should a reentry housing plan include?

A confirmed bed rather than a referral list, medication continued without a gap on release day, a first clinical appointment already booked, and a home that accepts residents on medication. Arrange all four before the release date, not after.

Finding Housing for Release

Browse sober homes in Massachusetts, 354 listed, or the 269 certified homes that have been independently inspected, filtering by gender, certification, and affiliation. Other states have their own pages in the directory.

Ask every home two questions: whether it accepts residents on medication for opioid use disorder, and whether it will hold a bed for a release date. Picking a sober house covers the rest, and what comes after detox makes the same argument for anyone leaving treatment rather than custody.

If cost is the obstacle there are more ways to pay for sober living than most families are told, and a case manager or reentry coordinator can often reach funding a family cannot see. The SAMHSA National Helpline at 1-800-662-4357 is free, confidential, and staffed 24 hours a day. The words used about someone leaving custody shape how they are treated by everyone who reads the file afterwards.

Sources

• National Institute on Drug Abuse. Criminal justice DrugFacts.
• National Institute on Drug Abuse. (2024). Fewer than half of U.S. jails provide life-saving medications for opioid use disorder.
• U.S. Department of Justice, Civil Rights Division. (2022). The ADA and opioid use disorder.
• Substance Abuse and Mental Health Services Administration. (2026). Recovery housing: Funding sources and financial sustainability (PEP26-08-001).
• Sober House Directory listing counts for Massachusetts, retrieved 18 September 2026.