For these with dependancy, 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 cover caption

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Ash Adams for NPR On the Ninilchik Neighborhood Clinic on Alaska's rural Kenai peninsula this summer time, 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 likely to be 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 just a little 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. Even if these lately launched from incarceration are a number of the most weak to dying from drug overdose, dependancy specialists say that many jails and prisons across the nation do not present medicine therapy.

Organizations just like the Ninilchik Neighborhood Clinic say they do what they'll to deal with individuals going into or popping out of jail or jail, however can not help these inside. And based on dependancy medication specialists, any interruptions in therapy might make it tougher for individuals to remain in restoration – and survive their opioid dependancy.

"I actually wished to do good" Spencer's affected person on the clinic that day in August was a girl 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 medication in jail, and she or he wished to get these pictures 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 need to go backwards."

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

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

"There isn't any inhabitants that is at larger danger than individuals who have been lately 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 cover caption

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Ash Adams for NPR Analysis backs up the concept individuals despatched to jails and prisons are extremely weak to drug demise. Federal knowledge launched by the Biden administration confirmed as much as 1 in 4 overdose deaths nationally in 2021 concerned individuals "lately launched from jail or jail." And one Nationwide Institute of Well being research discovered that within the weeks after being launched from jail, individuals had been as much as 40 occasions extra more likely to die from overdoses in contrast with the overall inhabitants.

H. mentioned the therapy 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 bought out.

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

Limitations on therapy 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 therapy to individuals who had been already getting it earlier than incarceration. Nobody will get therapy for greater than a month, except they're pregnant. When persons are launched, DOC mentioned they offer some a listing of suppliers they'll go to for therapy.

However Spencer mentioned finest apply is to make it a lot simpler for any inmate to begin and keep on medicine and to supply them with a transition plan – like DOC organising 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 numerous instances between sufferers. When not seeing sufferers within the cellular clinic, each spend their time on the cellphone and laptop – following up with sufferers, connecting them with sources, and fielding questions. Ash Adams for NPR cover caption

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Ash Adams for NPR DOC mentioned their intention is to develop entry to medicine for opioid use dysfunction, they usually hope to pilot a extra complete program by February of 2026.

Spencer mentioned within the absence of complete therapy, her group tries their finest to supply 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 courtroom docket for energetic warrants – and helps those that she is aware of have opioid use dysfunction get therapy earlier than they go in.

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

A contrasting method in Rhode Island Spencer mentioned she needs Alaska's system had been extra like Rhode Island's. In 2016, the state began providing therapy for substance use problems to anybody eligible in DOC care. Inside a yr, there had been a 61% discount in overdose demise charges amongst individuals lately 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 medication with one hand tied behind my again."

Based on Clarke, the outcomes of the brand new program had been palpable: when individuals weren't going by means of withdrawal and having cravings, they might focus higher on restoration.

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

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

"I used to be known as steadily a drug pusher," she mentioned. "So with the medical employees, I might simply discuss knowledge. 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 comparable life-saving medicine applications. In a latest 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 will be laborious to entry for anybody with opioid use dysfunction, and sometimes jails and prisons haven't got suppliers with the experience crucial to provide the medicines.

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

And since medicines 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 cover caption

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Ash Adams for NPR "You may hear quite a lot of issues about 'diversion' and about tablets being diverted, however there are methods to take care of and get round that, both by means of different formulations or by means 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 tougher to divert.

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

"It could simply be so enormous to have the ability to get it in jail too, after which achieve that energy to have the ability to assist your self whenever 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 bought out, she'd go proper again to therapy. If she does, it might save her life.