Only 12.8% of U.S. jails make MOUD available to all inmates with opioid use disorder, despite 129x overdose death risk in the two weeks after release

While an estimated 65% of incarcerated people have a substance use disorder, only 43.8% of the 1,028 U.S. jails surveyed by NIDA in 2024 offered any form of medication for opioid use disorder, and only 12.8% made it available to anyone with the diagnosis. Why it matters: incarcerated individuals with untreated opioid use disorder lose their physiological tolerance during weeks or months of forced abstinence, so upon release they return to opioid use at pre-incarceration doses their bodies can no longer handle, so formerly incarcerated people face a 129-fold increased overdose death risk in the first two weeks post-release (Washington State data), so tens of thousands of preventable deaths occur annually in the reentry window, so the criminal justice system repeatedly cycles the same individuals through arrest, incarceration, release, overdose, and re-incarceration at enormous human and fiscal cost. The structural root cause is that most U.S. correctional systems treat addiction as a behavioral or moral issue rather than a chronic medical condition, leading sheriffs and jail administrators to resist offering MOUD due to stigma, diversion concerns, and lack of medical infrastructure, even though a 2025 New England Journal of Medicine study showed jail-based MOUD cuts post-release fatal overdose risk by 52% and all-cause mortality by 56%.