Medication-Assisted Treatment in Hawaii Jails and Prisons: Why It Matters

Medication-assisted treatment, often called MAT or more recently medication for opioid use disorder (MOUD), is one of the most important tools in modern correctional health care. In jails and prisons, it combines FDA-approved medications with counseling and recovery support to treat substance use disorders, especially opioid use disorder. In Hawaii, the topic is especially relevant because the state's correctional system includes both island jails and prisons, and many people entering custody have a history of substance use disorder. Hawaii's correctional agencies now describe their mission as rehabilitative, restorative, and reentry-focused, which makes treatment access a central public-safety issue rather than just a medical one. ([dcr.hawaii.gov](https://dcr.hawaii.gov/))

How Hawaii's Correctional System Is Organized

Hawaii's system is unusual because the state operates both jails and prisons across multiple islands. The Correctional Institutions Division oversees four jails and four prisons. The jails hold pretrial detainees, short-term misdemeanant sentences, and some transitional sentence felons nearing release. The prisons include facilities on Oahu and the Women's Community Correctional Center. That structure matters for MAT because people may move between county-like jail settings and longer-term prison settings, and continuity of care can be disrupted if treatment is not coordinated across facilities and after release. ([dcr.hawaii.gov](https://dcr.hawaii.gov/about/divisions/corrections/))

Why MAT in Custody Is a Public Health Issue

People leaving jail or prison face a high-risk period for relapse and overdose, especially if they were forced to stop medication during incarceration. Correctional health experts in Hawaii have testified that a large share of incarcerated people have a substance use disorder history, and that relapse risk after release is especially high without treatment. Nationally, correctional health standards increasingly recognize that substance use disorder should be treated as a chronic medical condition, not simply a disciplinary problem. In practice, that means jails and prisons need screening, medication access, counseling, and discharge planning that begins before release. ([hcsoc.hawaii.gov](https://hcsoc.hawaii.gov/wp-content/uploads/2022/10/2022.9.23-Testimony-Substance-Use-Disorder-treatment-in-Jails-and-Prisons.pdf))

What Medication-Assisted Treatment Looks Like in a Jail or Prison

In correctional settings, MAT usually refers to medications such as buprenorphine, methadone, or naltrexone, paired with behavioral health services. The exact medication depends on the person's diagnosis, medical history, and clinical goals. In a jail, MAT may be used to continue a person's existing treatment, start treatment for withdrawal management and stabilization, or prepare someone for community care after release. In a prison, the longer stay can allow more structured treatment planning, but it also requires careful coordination with security, medical staffing, and outside providers. ([hcsoc.hawaii.gov](https://hcsoc.hawaii.gov/jail-and-prison-regulations/))

What Hawaii Has Been Doing

Hawaii has been moving toward a more treatment-oriented correctional model for several years. State materials show that the Department of Corrections and Rehabilitation includes treatment programs, and annual reporting has referenced medication for opioid use disorder and medication-assisted treatment as part of correctional health services. Hawaii's broader substance use policy also emphasizes treatment access and continuity of care. In addition, the state's Medicaid-related planning has discussed testing whether better coordination can improve uptake and continuity of MAT after release. These are important signals that Hawaii is treating correctional MAT as part of a larger reentry and recovery strategy. ([dcr.hawaii.gov](https://dcr.hawaii.gov/programs/treatment-programs/))

There is also evidence of local implementation efforts. A 2022 testimony to the Hawaii Correctional System Oversight Commission described MAT work at Kauai Community Correctional Center and noted the practical need to expand treatment inside custody. While testimony is not the same as a statewide policy statement, it shows that MAT has been actively discussed and piloted within Hawaii's facilities. ([hcsoc.hawaii.gov](https://hcsoc.hawaii.gov/wp-content/uploads/2022/10/2022.9.23-Testimony-Substance-Use-Disorder-treatment-in-Jails-and-Prisons.pdf))

Why Continuity After Release Is the Hard Part

Starting MAT in custody is only the first step. The real test is whether treatment continues when a person returns to the community. In Hawaii, that challenge can be especially complex because residents are spread across islands, and access to providers may vary by location. Effective reentry planning should include a medication bridge, an appointment with a community provider, help with insurance or Medicaid coverage, and overdose prevention education. Without that handoff, the benefits of treatment inside jail or prison can be lost quickly. ([dcr.hawaii.gov](https://dcr.hawaii.gov/about/divisions/corrections/))

Common Barriers in Hawaii

• Geography: island-based care can make referrals and follow-up harder than in a single mainland metro area.

• Staffing: correctional facilities need clinicians trained in addiction medicine and protocols for safe prescribing.

• Security concerns: facilities must balance access to medication with diversion prevention and custody rules.

• Stigma: some people still view addiction treatment as optional, even though it is evidence-based care.

• Reentry gaps: release planning can fail if community appointments, transportation, and insurance are not arranged in advance.

Why This Matters for Families and Communities

When MAT is available in jails and prisons, it can reduce withdrawal suffering, support recovery, and lower the chance of overdose after release. That benefits not only the person in custody, but also families, employers, and communities that are affected by repeated arrests, emergency care, and preventable deaths. Hawaii's stated goal of a more rehabilitative correctional system aligns with this approach, because treatment inside custody can improve public safety when it is paired with strong reentry support. ([dcr.hawaii.gov](https://dcr.hawaii.gov/))

The Bottom Line

As of today, medication-assisted treatment in Hawaii jails and prisons is best understood as a growing part of the state's correctional health strategy, not a finished project. Hawaii has official recognition of treatment programs, correctional reform goals, and ongoing discussion about substance use disorder care in custody. The key question now is not whether MAT belongs in jails and prisons, but how consistently it can be delivered across islands, across facilities, and across the critical transition back to the community. For Hawaii, that continuity may be the difference between short-term stabilization and long-term recovery. ([dcr.hawaii.gov](https://dcr.hawaii.gov/))

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Information is sourced from publicaly available information and may be inaccurate