For decades, we’ve addressed drug problems by increasing arrests, but this approach has failed to deliver results. Today, more than 2 million people are incarcerated, and another 5 million live under some form of criminal justice supervision. Punitive drug laws and long sentences have disproportionately filled our prisons with people who have substance use disorders. About two-thirds of the prison population has a substance use disorder, with opioid use disorder being among the most common and severe. An estimated 15% of incarcerated people live with opioid use disorder, yet fewer than 10% receive effective treatment. The danger doesn’t end at the prison gate, though: People recently released from prison are up to 40 times more likely to die from an overdose than the general population.
Why the Risk Is So High
Justice-involved people with opioid use disorder are uniquely vulnerable. Intravenous use is common, polydrug use is widespread, and access to medications like methadone or buprenorphine, the gold standard for treatment, is limited in correctional settings.
After release, lowered tolerance can make even small amounts of opioids deadly. Add in unstable housing, poor health, unemployment, and the pull of old environments, and the risk of relapse and overdose spikes dramatically.
Strategies That Work
We know what can help. The problem is making these solutions the norm, rather than the exception.
- Pre-Arrest Diversion Programs. Instead of arresting people for low-level drug offenses, diversion programs connect them to treatment and services. Programs like PAARI and LEAD have received national attention and shown promising results in reducing recidivism and overdoses. However, to truly maximize their impact, these programs need to be available beyond just a few cities and open to more than “first-time” offenders.
- Drug Treatment Courts. These specialized courts address addiction as a root cause, linking people to care instead of lengthy prison sentences. They can reduce drug use and crime, but barriers remain, such as fees, bans on medication-based treatment, and strict eligibility rules that shut out many people who could benefit.
- Medication Treatment in Justice Settings. Methadone and buprenorphine save lives, reduce drug use, and lower re-arrest rates. Yet many prisons, jails, and even drug treatment courts still refuse to offer them, clinging to outdated myths that they “just replace one drug with another.” That belief is costing lives.
- Naloxone Access. This overdose-reversing medication should be standard issue for people leaving incarceration, as well as for police, family members, and community organizations. It’s easy to use, relatively inexpensive, and proven to save lives.
- Behavioral Health Crisis Teams. Some cities now send behavioral health teams instead of police to nonviolent, addiction-related 911 calls. Programs like CAHOOTS (Crisis Assistance Helping Out On The Streets) in Oregon and Denver Star (Support Team Assisted Response) in Colorado show promise in connecting people to treatment and preventing overdoses in real time.
Moving Forward
These aren’t radical ideas. They’re evidence-based solutions that already work in pockets across the country. But stigma, inconsistent policies, and funding gaps keep them from becoming standard practice.
If we truly want to reduce overdoses and keep people from cycling in and out of the justice system, we need to act on what we already know works: Expand diversion programs. Remove barriers to drug treatment courts. Make medication treatment and naloxone available to everyone who needs them. Scale up crisis response teams.
The tools are available. The real test is whether we have the resolve to make them the standard, and in the face of the overdose crisis, every delay puts more lives at risk.
