Wisconsin Policy Forum: Treatment behind bars: Medication for opioid use disorder in Wisconsin’s jails and prisons

State prisons and county jails in Wisconsin in recent years have significantly expanded access to medications for opioid use disorder for those held in their facilities, a new Wisconsin Policy Forum report finds.

However, some prisons and jails do not provide access to buprenorphine and methadone in particular, according to a survey of all state prisons and the great majority of county jails. Others provide access to certain individuals but not others, or to certain medications but not others. The outcome is that some incarcerated individuals who would benefit from access to the medications may not receive them.

Medications for opioid use disorder are an important tool to help people manage symptoms of opioid withdrawal, as well as recover from symptoms of active opioid addiction. Research also shows that individuals who are newly released from prison are at elevated risk for overdose fatalities.

Providing buprenorphine and methadone to individuals held in jails or prisons is associated with a reduction in overdose deaths after their release, as well as a decreased risk of death from any cause or of reincarceration. The report does not advocate for any specific policies with respect to these medications, but instead seeks to provide more information about them and their use in the state.

The Forum surveyed Wisconsin jails and prisons on their policies regarding access to these medications, then compared the results to those from the last statewide survey on this topic in 2021. Our findings reveal a significant increase in access during that period.

“Given the magnitude of these changes and the other available research, it is reasonable to think these practices have likely improved health and potentially even saved lives across the state,” the report finds.

Between 2016 and 2023, over 9,000 Wisconsinites died as a result of an opioid overdose. The number of annual opioid deaths has since fallen substantially in the state and around the country, but this remains one of Wisconsin’s most serious public health challenges.

Greater access in county jails, state prisons

The Forum conducted an online survey of all 71 Wisconsin county jails in late 2025. Fifty-eight jails completed the full survey, and seven more completed an abbreviated survey; together, these 65 counties account for 97% of the state’s jail population. According to survey respondents:

• At least one type of opioid use disorder medication is now available to at least certain individuals in 53 of the 65 responding jails (81.5%). This is more than double the 25 jails (41%) that provided access to at least one type of such medications in 2021, according to a survey conducted that year by the Wisconsin Department of Health Services. Of those 53 jails, 50 provide access to agonist medications such as buprenorphine or methadone.
• The Wisconsin Department of Corrections (DOC) also significantly increased access to these medications during this period, our survey found. In 2021, 13 of the 35 state DOC facilities that responded to the survey reported having some form of opioid medication available. According to the DOC, a total of 48 individuals received some form of opioid medication in 2021.
• By 2025, all 36 DOC facilities provide at least some medication access, in the form of continuing individuals’ existing buprenorphine or oral naltrexone prescriptions upon their arrival at the facility. The agency’s prisons and facilities provided opioid medication to 302 individuals in 2024.

Separately, the Forum also found that all state prisons now offer two doses of naloxone, an anti-overdose medication, to individuals with a history of substance use when they leave prison. This is something that no state prisons offered in 2021.

In some facilities and for some medications, access gaps remain

This increase in access to these medications is likely due to several factors. The number of overdose deaths may have driven action, and the availability of funding from opioid lawsuit settlements likely played a role as well. Organizations such as the American Society of Addiction Medicine have urged jails to offer opioid medication to people in custody, and the U.S. Department of Justice has stated that jails are required to provide such medications under the Americans with Disabilities Act. Our report found:

• Although the increase in the number of prisons and jails providing these medications is notable, not everyone in their custody with opioid use disorder is eligible to receive them. At least eight county jails, mostly in small and rural counties, do not provide any access to these medications, and five additional jails did not respond to our survey.
• While the number of jails providing another medication, methadone, has jumped from three to 24, most jails still do not provide it. Out of the 47 county jails that responded to our survey question about whether they initiate opioid medication, 16 said they did not. In addition, most state corrections facilities do not initiate people on agonist medications such as such as methadone and buprenorphine, and different jails have different policies regarding who is allowed to receive these medications.

For state and county corrections officials, decisions about whether to expand access to medications will be considered based on a range of factors unique to their facilities and budgets. County jails, in particular, face challenges related to the cost and staffing requirements of their facilities. For those counties that may wish to expand access, jail administrators may wish to seek efficiencies by building or expanding regional teams of substance use and opioid treatment specialists. This might occur by
collaborating with other counties, state DOC institutions, or private vendors. They also might be able to draw on opioid settlement funds to help pay for startup costs or ongoing operations.

Click here to read the report. It was commissioned by Vital Strategies, a global nonprofit public health organization. Vital Strategies’ overdose prevention program works to strengthen and scale evidence-based solutions to reduce overdose deaths in Wisconsin and several U.S. states.

The Wisconsin Policy Forum is the state’s leading source of nonpartisan, independent research on state and local public policy. As a nonprofit, our research is supported by members including hundreds of corporations, nonprofits, local governments, school districts, and individuals. Visit wispolicyforum.org to learn more.