Medication-Assisted Treatment in North Carolina Jails and Prisons

Medication-assisted treatment, often called MAT or more broadly medication for opioid use disorder (MOUD), is one of the most important tools in modern addiction care. In jails and prisons, it can mean the difference between stabilization and crisis, especially for people with opioid use disorder who are entering custody, staying in custody, or preparing to return home. In North Carolina, this issue is especially urgent because the state continues to expand treatment access while also working to reduce overdose deaths, improve reentry, and connect justice-involved people to care.

As of today, North Carolina is actively scaling its treatment system. The state announced in late August 2026 that it will soon have its 100th opioid treatment program location, along with three mobile units, and that opioid treatment programs have partnered with 56 jails across the state to continue MOUD for incarcerated people. That is a meaningful sign that jail-based treatment is no longer a niche idea in North Carolina; it is becoming part of the state's broader public health response. ([ncdhhs.gov](https://www.ncdhhs.gov/news/press-releases/2026/08/31/100th-opioid-treatment-program-coming-north-carolina-ncdhhs-continues-reduce-overdose-deaths))

Why MAT matters behind bars

People with opioid use disorder face elevated health risks when they enter custody and when they leave it. Withdrawal can be severe, untreated addiction can worsen during incarceration, and the period immediately after release is especially dangerous. North Carolina's Department of Health and Human Services has said that within the first two weeks after incarceration, formerly incarcerated people are 40 times more likely to die from an opioid overdose than the general population. That statistic helps explain why continuity of care is so important. ([ncdhhs.gov](https://www.ncdhhs.gov/news/press-releases/2025/02/07/ncdhhs-improves-access-mental-health-and-substance-use-care-people-involved-justice-system))

MAT is not just about reducing cravings. It is about keeping people medically stable, lowering overdose risk, and improving the chances that someone can engage in counseling, recovery planning, and reentry support. In correctional settings, the most common medications for opioid use disorder include methadone, buprenorphine, and naltrexone, though the right option depends on the person's diagnosis, medical history, and treatment plan. North Carolina's public health materials describe MOUD as a key part of evidence-based care for people involved in the justice system. ([ncdhhs.gov](https://www.ncdhhs.gov/second-quarter-summary-report-april-1-2025-june-30-2025/download?attachment=))

What North Carolina is doing now

North Carolina's current approach is built around expansion, coordination, and reentry. In 2025, the state reported that 44 jails partnered with treatment providers to provide methadone for inmates, and it also approved funding for MOUD education kits for all jails in the state. The same report noted that expansion has been challenged by staff turnover and uneven support from jail leadership, which is a practical reminder that policy alone does not guarantee implementation. ([ncdhhs.gov](https://www.ncdhhs.gov/second-quarter-summary-report-april-1-2025-june-30-2025/download?attachment=))

The state has also invested in broader justice-system behavioral health services. In February 2025, NCDHHS announced $11 million in funding for diversion and reentry programs, including services that help people involved in the justice system access treatment and community supports. That matters because MAT works best when it is connected to a larger care plan that includes housing, transportation, employment support, and follow-up treatment after release. ([ncdhhs.gov](https://www.ncdhhs.gov/news/press-releases/2025/02/07/ncdhhs-improves-access-mental-health-and-substance-use-care-people-involved-justice-system))

North Carolina is also building out its treatment infrastructure outside correctional facilities. The state's recent milestone of reaching 100 opioid treatment program locations, plus mobile units, suggests that more communities now have a stronger treatment network to support people leaving jail or prison. That network can make it easier for correctional facilities to coordinate intake, referrals, and post-release appointments. ([ncdhhs.gov](https://www.ncdhhs.gov/news/press-releases/2026/08/31/100th-opioid-treatment-program-coming-north-carolina-ncdhhs-continues-reduce-overdose-deaths))

How MAT is being used in jails

In practical terms, jail-based MAT can happen in several ways. Some facilities continue a person's existing medication when they enter custody. Others start treatment during incarceration if a clinical assessment shows it is appropriate. In North Carolina, opioid treatment programs may either deliver medication to the jail or come on site to treat patients directly, which gives counties more than one model for implementation. ([ncdhhs.gov](https://www.ncdhhs.gov/news/press-releases/2026/08/31/100th-opioid-treatment-program-coming-north-carolina-ncdhhs-continues-reduce-overdose-deaths))

This flexibility is important because jails vary widely in size, staffing, medical capacity, and access to outside providers. A large urban jail may have different needs than a small rural jail. North Carolina's public health guidance and toolkit materials reflect that reality by focusing on operational issues such as medication handling, care coordination, and overdose prevention. The state's Injury and Violence Prevention Branch also maintains jail-health and MAT resources for local systems. ([ivp.dph.ncdhhs.gov](https://ivp.dph.ncdhhs.gov/))

• Continue a person's existing MOUD when clinically appropriate.
• Start treatment for people diagnosed with opioid use disorder during custody.
• Coordinate with outside opioid treatment programs and community providers.
• Plan for release early so treatment does not stop at the jail door.
• Pair medication with overdose prevention education and naloxone access.

What makes North Carolina's approach notable

North Carolina stands out because it is treating jail-based MAT as part of a statewide system, not just a local pilot. The state's 2025 Olmstead Plan update described a deliberate effort to expand MOUD in jails and prisons, including both starting medication and continuing it for people already on treatment. It also noted that the State Opioid Treatment Authority connected with the president of the North Carolina Sheriffs' Association, a sign that correctional leadership is being brought into the conversation. ([ncdhhs.gov](https://www.ncdhhs.gov/second-quarter-summary-report-april-1-2025-june-30-2025/download?attachment=))

That kind of coordination matters. Sheriffs, jail administrators, clinicians, county commissioners, and state agencies all influence whether MAT is available in a given facility. North Carolina's recent legislative and administrative activity suggests that the state is trying to align those actors around a common goal: reducing overdose risk and improving continuity of care for incarcerated people with substance use disorders. ([ncleg.gov](https://www.ncleg.gov/EnactedLegislation/SessionLaws/HTML/2025-2026/SL2026-38.html))

Challenges that still remain

Even with progress, major barriers remain. Staffing shortages, training gaps, inconsistent local buy-in, and limited medical infrastructure can all slow implementation. Rural counties may struggle to recruit providers or coordinate with treatment programs. Some jails may still lack clear protocols for intake screening, medication verification, or release planning. North Carolina's own reporting acknowledges that expansion has been difficult in some places because of staff turnover and different levels of support from jail leaders. ([ncdhhs.gov](https://www.ncdhhs.gov/second-quarter-summary-report-april-1-2025-june-30-2025/download?attachment=))

Another challenge is making sure treatment does not end when a person leaves custody. Reentry is often the highest-risk period, and medication continuity is critical. That is why North Carolina's investment in reentry services, diversion programs, and community treatment capacity is so important. MAT is most effective when it is part of a bridge from custody to community care, not a short-term intervention that stops at release. ([ncdhhs.gov](https://www.ncdhhs.gov/news/press-releases/2025/02/07/ncdhhs-improves-access-mental-health-and-substance-use-care-people-involved-justice-system))

What families and communities should know

For families, advocates, and community leaders, the key takeaway is that North Carolina is moving in the right direction, but access is still uneven. Some jails now offer methadone or other MOUD through treatment partnerships, while others may still be developing their programs. The state's public health system is clearly signaling that treatment in custody is a priority, and the growing number of opioid treatment programs should help support that effort over time. ([ncdhhs.gov](https://www.ncdhhs.gov/news/press-releases/2026/08/31/100th-opioid-treatment-program-coming-north-carolina-ncdhhs-continues-reduce-overdose-deaths))

For communities, the broader lesson is simple: treating opioid use disorder in jail and prison is not a luxury or a reward. It is a public health strategy that can reduce overdose deaths, improve safety, and support successful reentry. In North Carolina, that strategy is becoming more visible, more coordinated, and more closely tied to the state's overall behavioral health system. ([ncdhhs.gov](https://www.ncdhhs.gov/news/press-releases/2026/08/31/100th-opioid-treatment-program-coming-north-carolina-ncdhhs-continues-reduce-overdose-deaths))

The bottom line

Medication-assisted treatment in North Carolina jails and prisons is evolving from an isolated practice into a statewide priority. The state has expanded opioid treatment capacity, increased jail partnerships, invested in reentry support, and continued to frame MOUD as evidence-based care. There is still work to do, especially in rural areas and in facilities with limited staffing, but the direction is clear: North Carolina is building a correctional health model that treats addiction as a medical condition and continuity of care as a public safety issue. ([ncdhhs.gov](https://www.ncdhhs.gov/news/press-releases/2026/08/31/100th-opioid-treatment-program-coming-north-carolina-ncdhhs-continues-reduce-overdose-deaths))

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