Addiction Medicine Behind Bars May Make Jails Safer, Study of Rhode Island Facilities Finds

Opioid addiction treatment has long been a point of friction inside American jails and prisons, where medications for opioid use disorder were historically treated as contraband to be banned rather than medicine to be dispensed. A new qualitative study published in BMC Public Health suggests that when these treatments are delivered consistently and supported by leadership, they can do more than save lives: they can measurably change the culture, operations, and safety of correctional facilities themselves. Drawing on interviews with incarcerated people and staff at the Rhode Island Department of Corrections, the research offers one of the most detailed pictures yet of what happens when a jail system fully commits to medication-based addiction treatment.

The research team, led by Justin Berk of Alpert Medical School at Brown University and the Center for Health and Justice Transformation, focused on a system that has become a national reference point. The Rhode Island Department of Corrections is a unified state system housing both pretrial and sentenced individuals, and it has operated one of the longest-running medications for opioid use disorder programs in the United States, in place since 2016. That longevity made it an ideal setting to ask a question that clinical trials rarely capture: what does medication-assisted treatment actually do to the daily workings of a correctional institution over years of implementation?

Methodologically, the study relied on semi-structured qualitative interviews with nineteen incarcerated individuals and ten correctional and medical facility staff. The interviews explored the cultural and operational context of medication implementation, including experiences with extended-release injectable buprenorphine, a long-acting formulation administered monthly that has become increasingly important in correctional settings. All interviews were audio-recorded and transcribed, and the researchers analyzed them using applied thematic analysis, a systematic qualitative method that identifies recurring patterns of meaning across participant accounts. The study received approval from the Brown University Health Institutional Review Board and the Rhode Island Department of Corrections Medical Research Advisory Group, and all participants provided written informed consent.

Three major themes emerged from the analysis, and the first concerns what researchers call facility climate. Participants perceived that the availability of opioid use disorder medications reduced contraband drug use, violence, and disciplinary infractions within the facilities. This is a significant finding because contraband opioids, particularly illicit fentanyl, have become a central security and public health threat in jails across the country. When incarcerated people can obtain evidence-based treatment that relieves cravings and prevents withdrawal, the black-market demand that drives smuggling, debt, and violence may shrink. Interviewees also described improvements in social functioning, including greater participation in court proceedings and rehabilitative programming, suggesting that stabilized patients engage more constructively with the legal and institutional processes they must navigate.

The second theme directly addresses the objection most often raised by skeptics of prison-based addiction treatment: diversion, the practice of saving or trading medication doses for other purposes. Diversion did occur in the Rhode Island system, participants reported, often to get high or to manage withdrawal symptoms. But interviewees perceived it as limited in scope, and most patients were perceived to use their medications as prescribed. Importantly, participants emphasized that diversion is not unique to opioid treatment medications; it also occurs with other prescribed drugs in correctional settings. From a security-management perspective, this reframes diversion from a disqualifying danger into a routine, manageable clinical and operational problem comparable to those already handled with other medications every day.

Extended-release injectable buprenorphine emerged as a particularly effective tool in this regard. Because the medication is a monthly depot injection administered under clinical supervision rather than a daily tablet that passes through many hands, it was widely regarded by participants as a strategy that reduces both diversion risk and operational burden. Daily observed dosing of medication is labor-intensive for medical staff and creates choke points that custody staff must manage; a monthly injection collapses that logistical challenge. For administrators weighing the costs of running a medication program, the injectable formulation appears to offer a practical compromise that preserves clinical benefit while addressing the security concerns that most commonly stall implementation.

The third theme is the most culturally revealing: even in a system with nearly a decade of continuous program operation, stigma toward these medications persisted among some custody staff and some incarcerated peers. Skepticism about whether opioid agonist treatment constitutes real recovery, or whether it merely substitutes one drug for another, remains a durable cultural artifact within corrections. The study identifies education and leadership support as the critical levers for overcoming this resistance. Programs that invested in training and in visible, sustained buy-in from leadership were better positioned to convert skeptics and to integrate addiction treatment into the institutional identity rather than treating it as an exception or an imposition.

Notably, the researchers found that medication implementation created opportunities for improved collaboration between medical and security staff, even though some tensions remained. In many facilities, healthcare units and custody operations function as parallel hierarchies with different priorities: one oriented toward health, the other toward order. A shared program like medications for opioid use disorder forces the two sides into regular coordination, from dosing logistics to responding to diversion incidents, and participants described how this contact could build mutual understanding. The tensions that persisted did not disappear, but the study suggests the medication program itself can serve as a structure through which interdisciplinary working relationships develop.

The implications extend well beyond Rhode Island. Most jails and prisons in the United States still do not offer all three FDA-approved medications for opioid use disorder, and diversion fears remain the most commonly cited barrier. People leaving incarceration face a dramatically elevated risk of fatal overdose in the days and weeks after release, a phenomenon documented repeatedly in the public health literature, because tolerance lost during abstinence meets unchanged patterns of use. Treatment that begins inside and continues after release is among the strongest known protective factors. If implementing such treatment also reduces violence and disciplinary problems inside, as this study’s participants perceived, then the institutional case for medication programs becomes considerably harder to dismiss on purely administrative grounds.

The authors caution, appropriately, that these are perceptions gathered from a single state system with an unusually mature program, and qualitative findings describe lived experience rather than measuring outcomes directly. But the study’s conclusions are clear and actionable: medications for opioid use disorder in correctional settings can support a safer, more stable facility environment, diversion concerns appear manageable and comparable to those of other medications, and programs that invest in education, leadership engagement, and medical-security partnerships are best positioned to overcome resistance. For a nation whose jails have become de facto frontline institutions of the overdose crisis, the Rhode Island experience suggests that the contraband-versus-medicine debate may finally be resolving in favor of medicine, and that the benefits flow to security officers, medical staff, incarcerated people, and the communities they return to alike.

Subject of Research: Qualitative study of how medications for opioid use disorder reshape culture, operations, and safety in correctional facilities

Article Title: From contraband to collaboration: a qualitative study of how medications for opioid use disorder can reshape correctional culture and safety

Article References: Berk, J., Martin, M., Cook, M., Miller, C., Suh, M., Murphy, C., Jack, H. E., Rich, J. D., Brinkley-Rubinstein, L., & Guthrie, K. M. (2026). From contraband to collaboration: a qualitative study of how medications for opioid use disorder can reshape correctional culture and safety. BMC Public Health. https://doi.org/10.1186/s12889-026-29554-9

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29554-9

Keywords: opioid use disorder, medications for opioid use disorder, buprenorphine, correctional health, jails and prisons, diversion, harm reduction, implementation science, qualitative research, overdose prevention, correctional culture, public health