Only 12 states and the federal Bureau of Prisons offer both continuation and initiation of medications for opioid use disorder (MOUD) in every facility. Some state prison systems offer these opportunities at only some of their facilities, while others further restrict access to MOUD while incarcerated. For a handful of states, we were not able to find any evidence that they provide MOUD of any kind in state prisons.
Sourcing: Compiled by Prison Policy Initiative from the Jail & Prison Opioid Project (last updated 2022) and A Review of Medication Assisted Treatment (MAT) in United States Jails and Prisons from the California Correctional Health Care Services (2023), updated with information collected from news coverage and individual state prison system websites. For the data underlying this map, see the Appendix Table.

Substance use disorders are among the most pressing and least addressed medical conditions facing incarcerated people. While half of people in state prison have substance use disorders — far outpacing the national prevalence of 8% — only around 10% of people in state prison in 2019 had received clinical treatment in the form of a residential treatment program, professional counseling, detoxification unit, or medication-assisted treatment. In recent years, advocates in states like New York have won hard-fought reforms to expand access to treatment for those behind bars. However, while we have some information about substance use disorders and treatment among incarcerated people, it’s hard to get a good picture of how these reforms are being implemented without the insights and experiences of the people actually participating in these treatment programs.

In December 2024, the civilian oversight body of the New York state prison system — the Correctional Association of New York (CANY) — published their report on medication-assisted treatment (MAT) for opioid use disorder in New York prisons. The report, which found increasing numbers of people enrolling in the program each month since it was introduced, underscores the importance of expanding access to medications for opioid use disorder (MOUD). It also examines the inherent problems with providing healthcare under the supervision of correctional staff and the value of participant perspectives for evaluating program implementation.

The Correctional Association report highlights the positive impact that expanded access to MOUD behind bars can have on people’s lives, and offers opportunities for the New York Department of Corrections and Community Supervision to improve their treatment program to better meet the needs of incarcerated people. Research suggests that MOUD during incarceration can have profound positive impacts on the health and mortality of participants after their release from prison: it’s associated with increased community-based treatment participation and reduced opioid use and overdoses after release. Almost 4,000 people in New York state prisons receive MOUD, underscoring the need for comprehensive, supportive, and evidence-based substance use disorder treatment behind bars. These lessons are valuable beyond state borders: other jurisdictions can learn from New York’s experience implementing such a program and incorporate the Correctional Association’s recommendations from the start. Ensuring policies are publicly available to incarcerated people and the community, expanding substance use education for staff, reducing conflicts between MOUD programming and other programs, and guaranteeing access to appropriate counseling and peer support for medication-assisted treatment participants are all lessons that can help other states get off to a strong start and ensure incarcerated people have genuine access to the medical care they need.