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When we talk about the opioid crisis, we often picture street corners, rural clinics, or harrowing overdose statistics. We rarely picture the county jail. Yet, the intersection of mass incarceration and the opioid epidemic has created one of the most pressing and hidden human rights catastrophes in modern America – the criminalization of medical withdrawal.
Every year, hundreds of thousands of Americans with Opioid Use Disorder (OUD) pass through correctional facilities. For decades, the medical gold standard for treating this chronic condition has been Medication for Opioid Use Disorder (MOUD), such as methadone or buprenorphine (Suboxone). These medications stabilize brain chemistry, curb profound cravings, and allow individuals to function normally.
However, in the majority of U.S. jails, this life-saving standard of care often stops at the sally port. Driven by stigma and outdated “tough on crime” philosophies, many facilities deny incoming inmates their prescribed addiction medication. This forces patients into agonizing withdrawal while incarcerated. More dangerously, it erases their physiological tolerance to opioids; when these individuals are released without treatment, they often return to use, but their bodies can no longer handle previous dosages. This makes them significantly more likely to suffer a fatal overdose shortly after release.
The human cost: A descent into agony
To understand the brutality of this policy, one must look beyond policy papers and into a jail cell. While many accounts exist in court filings and advocacy reports, Melissa Godsey’s experience illustrates the common reality.
The American Civil Liberties Union (ACLU) of Washington sued the Bureau of Prisons (BOP) on Melissa’s behalf.
Melissa had been in recovery for over a year. While she was in recovery, she was sentenced to two years and one day in prison. At that time, policies didn’t allow for her treatment inside prison facilities, which put her at an increased risk of painful and unnecessary withdrawal. But this experience is not unusual. In fact, only 58 percent of U.S. jails offer MOUD to anyone who needs it.
When a person with OUD uses opioids regularly, their body develops a high tolerance. So if they are incarnated, they are forced into abstinence for weeks or months, and that tolerance evaporates. Their brain, however, still remembers the addiction and the cravings. And not only that, but sudden withdrawal also causes symptoms such as cravings, problems with sleep, irritability or agitation, depression or anxiety, and many more symptoms.
Upon release, the psychological stress of reentry — finding housing, employment, and facing stigma — is immense. Relapse is common. But the body that leaves jail is physically “drug naïve.”
If a newly released person uses the same dose they took before being locked up, it will overwhelm their system. Furthermore, with the street supply now saturated with illicit fentanyl, the margin for error is nonexistent.
This phenomenon has created this death gap – a gap that shows, according to a 2024 study published in Health Justice, that in the first two weeks following release from incarceration, an individual’s risk of dying from an overdose is 40 to 130 times higher than the general population.
By denying MOUD, the correctional system is essentially spending taxpayer money to lower a person’s tolerance so effectively that their next relapse is a death sentence.
A slow awakening
The tide is beginning to turn, driven largely by the courts. Federal judges are increasingly ruling that denying MOUD is not just bad medicine; it is illegal.
Denying evidence-based care to a suffering inmate can be construed as “deliberate indifference to a serious medical need,” a violation of the Eighth Amendment’s prohibition against cruel and unusual punishment. Furthermore, because OUD is recognized as a disability, blanket denials of treatment are being successfully challenged as violations of the Americans with Disabilities Act (ADA).
Some states, like Rhode Island, have mandated MOUD throughout their correctional systems and have seen dramatic, double-digit drops in post-release overdose deaths.
But for the majority of jails across America, the punitive approach remains. Until addiction is treated honestly as a medical condition rather than a moral failing within the justice system, the cycle of arrest, torture by withdrawal, release, and death will continue unabated.
This article was written as part of a program to educate youth and others about Alameda County’s opioid crisis, prevention and treatment options. The program is funded by the Alameda County Behavioral Health Department and the grant is administered by Three Valleys Community Foundation.
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