State prisons expand medication treatment to reduce deadly post-release overdoses.
People leaving prison in North Carolina often face a stretch of time that can be far more dangerous than anything they experienced behind bars. A large share of people entering state prisons have a history of substance use, and many have gone long periods without access to the drugs they once used daily. When they return to the community, many try to use again before finding a treatment provider, and that first attempt can be deadly. Studies in the state have shown that the risk of a fatal overdose shoots up in the first weeks after release, with rates many times higher than those seen in the general population. This rise in risk is tied to a sharp drop in tolerance and the growing strength of many drugs sold on the street. These factors have pushed state officials to try new ways to help people stay alive during this vulnerable window.
Over the past few years, the state’s prison system has expanded access to medications that treat opioid use disorder. These medications, including buprenorphine, methadone, and naltrexone, help steady the body, lower cravings, and bring down the chance of an overdose. Research shows that people who receive this care while still incarcerated are more likely to avoid using dangerous street drugs after release, less likely to spread infections, and less likely to return to the justice system. What began in 2021 as a small pilot program in two prisons has now grown to cover about half the state’s facilities. In the past year alone, more than a thousand people left custody with medication already active in their system. Leaders in the program believe this has saved lives, giving many a fighting chance to stay stable long enough to connect with a community provider.
Staff members screen people about two months before release. Those who qualify start with several days of oral medication, followed by a long-acting shot shortly before going home. The shot lasts about a month, offering a buffer of time when cravings and withdrawal symptoms stay under control. This is especially important because many people leaving prison lack steady housing, transportation, or safe storage for medications. The injection acts as a built-in safeguard during the first few weeks, when overdose risk is highest. After release, people are handed off to community programs that help them continue care. These programs cover most of the state and work with virtual providers so that treatment can continue even in rural areas.
Still, the reach of the program is limited. Of the more than 18,000 people who leave prison each year, several thousand could likely benefit from this treatment if it were offered in all facilities. Funding remains the main obstacle. When federal grant money ran out, the state had to cover the costs itself, straining an already tight budget. The prison system has asked for additional recurring funds to expand the program and bring staffing up to levels needed for full coverage. Until then, officials have placed further expansion on hold.
Even with these hurdles, the efforts continue to grow. Every person leaving prison now receives a dose of Narcan, the opioid-reversal spray. Officials plan to continue this as long as resources allow. Community groups and medical teams say the progress already made is promising, and many people who received medication before release credit it with helping them stay alive during the hardest stretch of their transition home.
Sources:
NC prisons ramp up opioid addiction treatment before release
Work underway to prevent opioid overdoses for people leaving prison
Join the conversation!