For these with habit, going into and popping out of jail generally is a minefield. : NPR

[ad_1] <img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4500x3375+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Feb%2F1c%2Fe0c67d594a0e8dc86492ae4d3f3f%2F251126-aa-akaddictiontreatment-106.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4500x3375+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Feb%2F1c%2Fe0c67d594a0e8dc86492ae4d3f3f%2F251126-aa-akaddictiontreatment-106.jpg" class="img" alt="Dr. Sarah Spencer and Case Manager Annette Hubbard see a patient in the mobile clinic outside of a shelter in Kenai, Alaska on November 20, 2025." fetchpriority="high"/> Dr. Sarah Spencer and Case Supervisor Annette Hubbard see a affected person within the cellular clinic outdoors of a shelter in Kenai, Alaska on November 20, 2025. Ash Adams for NPR conceal caption

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Ash Adams for NPR On the Ninilchik Neighborhood Clinic on Alaska's rural Kenai peninsula this summer season, Dr. Sarah Spencer stood subsequent to a affected person mendacity on an examination desk, and swiped her stomach with alcohol. The affected person was there for a month-to-month buprenorphine shot to deal with her opioid use dysfunction – a shot she thought is perhaps her final for some time since there was a warrant out for her arrest. The Alaska Division of Corrections doesn't present complete entry to this life saving medicine.

"I am gonna offer you a bit pinch," Spencer mentioned, sliding the needle right into a fold of pores and skin on the affected person's stomach for the subcutaneous injection.

Alaska's not an outlier. Although these not too long ago launched from incarceration are among the most susceptible to dying from drug overdose, habit consultants say that many jails and prisons across the nation do not present medicine remedy.

Organizations just like the Ninilchik Neighborhood Clinic say they do what they will to deal with individuals going into or popping out of jail or jail, however can not help these inside. And in line with habit drugs specialists, any interruptions in remedy might make it more durable for individuals to remain in restoration – and survive their opioid habit.

"I actually wished to do good" Spencer's affected person on the clinic that day in August was a lady who requested that NPR use solely her first preliminary, H., as a result of she criticized the Alaska Division of Corrections and she or he was afraid of retaliation from employees in jail. She mentioned she was anticipating to be incarcerated for about 6 months.

H. mentioned there are typically contraband medicine in jail, and she or he wished to get these photographs so she had the very best likelihood of staying sober whereas incarcerated.

"I wished to cowl my bases, as a result of I actually, actually wished to do good," H. mentioned. "I did not wish to go backwards."

Many research have proven that medicine for opioid use dysfunction makes restoration extra possible and reduces the danger of overdose dying.

If individuals aren't capable of get medicine whereas incarcerated, they could relapse in jail on black market medicine, or, if they do not use opioids inside, they may detox and their tolerance will go down. That makes them extra prone to overdose once they depart.

"There isn't a inhabitants that is at increased threat than individuals who have been not too long ago incarcerated and a giant a part of that's as a result of… it solely takes two weeks for individuals to lose their tolerance to opioids," Spencer mentioned.

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4500x3375+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F97%2Fe4%2F59b70517403392124565af403d78%2F251126-aa-akaddictiontreatment-110.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4500x3375+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F97%2Fe4%2F59b70517403392124565af403d78%2F251126-aa-akaddictiontreatment-110.jpg" class="img" alt="Dr. Sarah Spencer, Peer Support Specialist Harold Sargeant, and Case Manager Annette Hubbard set up at a location in Nikiski, Alaska on November 20, 2025." loading="lazy"/> Dr. Sarah Spencer, Peer Assist Specialist Harold Sargeant, and Case Supervisor Annette Hubbard arrange at a location in Nikiski, Alaska on November 20, 2025. Ash Adams for NPR conceal caption

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Ash Adams for NPR Analysis backs up the concept individuals despatched to jails and prisons are extremely susceptible to drug dying. Federal information launched by the Biden administration confirmed as much as 1 in 4 overdose deaths nationally in 2021 concerned individuals "not too long ago launched from jail or jail." And one Nationwide Institute of Well being research discovered that within the weeks after being launched from jail, individuals have been as much as 40 instances extra prone to die from overdoses in contrast with the final inhabitants.

H. mentioned the remedy for her opioid use dysfunction was interrupted when she was incarcerated earlier in 2025. She mentioned the Alaska Division of Corrections denied her medicine and she or he began utilizing illicit opioids once more when she obtained out.

"It occurs tremendous quick," H. mentioned. "I did not have a telephone or something, however you run into individuals. You see individuals. It simply – there's 1,000 other ways."

Limitations on remedy Interviews with healthcare suppliers like Dr. Spencer and previously incarcerated individuals like H. point out that many who need medicine whereas incarcerated do not get it.

Alaska's Division of Corrections, or DOC, declined repeated requests for an interview for this story, however they responded to questions over e-mail.

They confirmed that they solely give 30 days of medicine remedy to individuals who have been already getting it earlier than incarceration. Nobody will get remedy for greater than a month, except they're pregnant. When persons are launched, DOC mentioned they provide some an inventory of suppliers they will go to for remedy.

However Spencer mentioned finest follow is to make it a lot simpler for any inmate to start out and keep on medicine and to offer them with a transition plan – like DOC establishing an appointment for them with a healthcare supplier locally – to assist them keep protected after launch.

"If a affected person is not continued on their medicine or is not provided medicine, you are actually lacking that chance to stabilize this life threatening illness whereas they're in DOC custody," she mentioned.

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/3000x2000+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Fb1%2F90%2F64d1285a4db8bde2bed4f47cf9f4%2Fak-diptych.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/3000x2000+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2Fb1%2F90%2F64d1285a4db8bde2bed4f47cf9f4%2Fak-diptych.jpg" class="img" alt="Dr. Sarah Spencer and Case Manager Annette Hubbard discuss various cases between patients. When not seeing patients in the mobile clinic, both spend their time on the phone and computer – following up with patients, connecting them with resources, and fielding questions." loading="lazy"/> Dr. Sarah Spencer and Case Supervisor Annette Hubbard talk about varied instances between sufferers. When not seeing sufferers within the cellular clinic, each spend their time on the telephone and pc – following up with sufferers, connecting them with assets, and fielding questions. Ash Adams for NPR conceal caption

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Ash Adams for NPR DOC mentioned their goal is to broaden entry to medicine for opioid use dysfunction, and so they hope to pilot a extra complete program by February of 2026.

Spencer mentioned within the absence of complete remedy, her group tries their finest to offer look after individuals earlier than and after incarceration, at the least on the Kenai peninsula.

Her colleague Annette Hubbard is a case supervisor who routinely checks the court docket docket for energetic warrants – and helps those that she is aware of have opioid use dysfunction get remedy earlier than they go in.

"I do this voluntarily, as a result of I do know that the those who I work with and for are all the time in danger," Hubbard mentioned.

A contrasting method in Rhode Island Spencer mentioned she needs Alaska's system have been extra like Rhode Island's. In 2016, the state began providing remedy for substance use problems to anybody eligible in DOC care. Inside a yr, there had been a 61% discount in overdose dying charges amongst individuals not too long ago incarcerated, and a 12% discount in overdose deaths statewide.

Dr. Jennifer Clarke developed this system as medical director on the Rhode Island Division of Corrections.

Earlier than she might freely dispense medicine for substance use problems, she mentioned, "it was like training drugs with one hand tied behind my again."

In line with Clarke, the outcomes of the brand new program have been palpable: when individuals weren't going by way of withdrawal and having cravings, they may focus higher on restoration.

"I heard a number of instances, individuals would inform me, 'This was the primary time I might actually take part within the remedy lessons, within the behavioral remedy,'" Clarke mentioned.

However she mentioned it wasn't all the time straightforward. This system required two million {dollars} in funding to start out, the backing of the then-governor, and it needed to overcome many logistical hurdles. And he or she mentioned, there was stigma.

"I used to be referred to as often a drug pusher," she mentioned. "So with the medical employees, I'd simply discuss information. I am like, 'We're scientists… We will observe the science.'"

Throughout the nation, inconsistent entry to care Different states have been gradual to develop related life-saving medicine packages. In a current research revealed in JAMA Community Open, consultant of over 3,000 U.S. jails, fewer than half provided some entry to medicine for opioid use dysfunction.

Redonna Chandler, a psychologist previously on the Nationwide Institute on Drug Abuse, mentioned medicine may be arduous to entry for anybody with opioid use dysfunction, and sometimes jails and prisons haven't got suppliers with the experience obligatory to provide the drugs.

"I believe it is nonetheless a patchwork of packages," Chandler mentioned.

And since drugs like buprenorphine are opioids themselves and assist alleviate signs of withdrawal, there are black markets for them inside jails and prisons.

<img src="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4500x3375+0+0/resize/1100/quality/50/format/jpeg/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F6b%2F8b%2F5c1e9020413db79052d90111bf73%2F251126-aa-akaddictiontreatment-117.jpg" data-template="https://npr.brightspotcdn.com/dims3/default/strip/false/crop/4500x3375+0+0/resize/{width}/quality/{quality}/format/{format}/?url=http%3A%2F%2Fnpr-brightspot.s3.amazonaws.com%2F6b%2F8b%2F5c1e9020413db79052d90111bf73%2F251126-aa-akaddictiontreatment-117.jpg" class="img" alt="Case Manager Annette Hubbard holds a box of Naloxene injections that she says the clinic receives from the Remedy Alliance." loading="lazy"/> Case Supervisor Annette Hubbard holds a field of Naloxene injections that she says the clinic receives from the Treatment Alliance. Ash Adams for NPR conceal caption

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Ash Adams for NPR "You may hear a number of considerations about 'diversion' and about tablets being diverted, however there are methods to take care of and get round that, both by way of different formulations or by way of the methods in which you'd administer the medicine," Chandler mentioned. That might imply shifting from tablets to injectable formulations, that are a lot more durable to divert.

Within the meantime, some sufferers like H. in Ninilchik could solely be capable to get remedy outdoors incarceration.

"It will simply be so enormous to have the ability to get it in jail too, after which acquire that energy to have the ability to assist your self if you did hit the streets once more," H. mentioned.

It is unclear when she is going to begin her new jail sentence, however she mentioned she hoped when she obtained out, she'd go proper again to remedy. If she does, it could save her life.