Many people in jail have an opioid addiction, but less than half of jails offer medication, study shows

Jails could play a key role in curbing overdose deaths, but less than half offer opioid use disorder medication, a new national study found. Only a fraction of those with such medication widely provide it to anyone with the disorder.

Minnesota is among the states where, in many counties, people go through withdrawal in jail cells and return to the community without receiving medication that can be pivotal to recovery.

“Those who are most in need of [opioid use disorder] treatment are the ones who are probably least likely to get it,” said Bruce Taylor, a senior fellow with NORC at the University of Chicago, who said their study published Tuesday was the first nationally representative survey on the topic.

Minnesota is also one of many places trying to expand access to the medication and ensure treatment continues after someone is released.

The Department of Human Services is applying for a federal waiver that would allow the state to use Medicaid dollars to provide services, including substance use treatment, to people for up to 90 days before they are released from jail or prison. States and counties currently must cover health care costs for most incarcerated people, contributing to the lack of funding for services like opioid use disorder medication.

“Federal policy requires Medicaid coverage to be suspended during incarceration leading to gaps in healthcare upon release,” DHS wrote in a memo Tuesday announcing the waiver project.

Studies indicate that access to addiction medication, such as buprenorphine, methadone and naltrexone, can reduce the number of deadly overdoses which frequently occur shortly after someone leaves jail or prison.

State officials are still working on their federal application and will submit it around the start of the new year, said Jeremy Drucker, director of Minnesota’s Office of Addiction and Recovery. DHS plans to start the project in January 2026, or whenever they get federal approval.

Minnesota is not the only state seeking the green light from the Centers for Medicare & Medicaid Services. A spokeswoman for the federal agency said they have approved such waivers for 11 states and are reviewing applications from 12 states and the District of Colombia.

The increase in applications has created a bottleneck, according to the National Conference of State Legislatures, which noted the federal approval process is averaging more than 15 months.

Not all jails or prisons will see the change if the state gets approved. The pilot program will include three state correctional facilities and seven local facilities. Sites that want to be part of the project need to apply, and DHS said Tuesday it is creating a competitive process to select the locations.

In additional to the Medicaid waiver project, Drucker said a workgroup to increase jail access to medications for opioid use disorder — co-chaired by the Minnesota Medical Association and Minnesota Sheriff’s Association — got started this summer. And he said the Department of Corrections is reviewing its rules for the minimum services that jails must offer, including requirements around health care and substance use disorders.

“Getting people treatment — good quality treatment including medications for opioid use disorder — while they’re incarcerated, helping them begin a recovery journey and then as they are exiting ... having them return to healthy recovery ecosystems is both good for individuals, in terms of their personal health, but also for communities,” Drucker said. “It reduces recidivism and increases public safety.”

Almost two-thirds of people in U.S. jails have some type of active substance use disorder, the report from the NORC at the University of Chicago states. It cites another another study that found a 31% reduction in post-incarceration overdose deaths among people who received opioid use disorder medications while detained.

The survey of jail officials found a lack of adequate or licensed staff was the most common reason why places aren’t giving people medication. Some places said policies, or the cost of the medications, are preventing them from offering the service.

The study was funded by the National Institutes of Health and included responses from 1,028 jails, 27 of which were in Minnesota. Senior research associate Elizabeth Flanagan Balawajder said they found about 70% of jails offered some sort of substance use disorder treatment or recovery support, such as Alcoholics Anonymous meetings.

But just about 44% of all jails surveyed offered medications for opioid use disorder to at least some individuals. Locations that only offered medication to some people often gave it to those who were receiving it when they entered jail, or to pregnant people, Flanagan Balawajder said.

Fewer than 13% offered the medication to anyone with opioid use disorder, researchers found.