Jails ranking
The prevalence of OUD is much higher among people in jails and prisons than it is among the general population.1 People with OUD have an especially high risk of death upon release from incarceration, because their tolerance for opioids decreases while they are incarcerated.2 A 2024 study in Minnesota found that overdose death rates were 15 to 28 times higher for people leaving jails and prisons than among the general population, with opioids being the leading cause of overdose.3
A strong approach to reducing opioid overdose deaths in jails requires access to treatment and harm reduction interventions both during incarceration and for those who are returning to community settings. These strategies include distribution of naloxone and enhanced connections to community-based MAT for people leaving incarceration.
The two indicators that make up the Jails Ranking are:
- Percent of local jail jurisdictions and facilities that provide overdose reversal medications to detainees with OUD upon release
- Percent of local jail jurisdictions and facilities that provide a link to MAT in the community to detainees with OUD upon release
The 10 states with the highest need for strategic investment in opioid overdose prevention during community reentry are: Mississippi, Arkansas, Alaska, Idaho, Louisiana, Oklahoma, Kansas, Texas, Alabama, and Montana. These states have the lowest reported rates of naloxone provision and connection to MAT for people with OUD who were leaving incarceration.
These indicators were collected by the Bureau of Justice Statistics (BJS) through the 2019 Census of Jails, a representative survey of the local jurisdictions and facilities in states with separate jail and prison systems. These data are collected every five years. The 2019 Census of Jails is the most recently available dataset for these measures. BJS has not done a similar collection of opioid use or treatment in prisons in the U.S.
*Connecticut, Delaware, Hawaii, Rhode Island, and Vermont have combined jail and prison systems and were excluded from this data collection and ranking. Alaska data is reflective of 15 locally operated jails outside of the combined jail and prison system.
1. Duncan, A. & Schiff, M. (2023). U.S. should fund opioid use disorder treatment in correctional facilities. Pew. https://www.pew.org/en/research-and-analysis/articles/2023/10/12/us-should-fund-opioid-use-disorder-treatment-in-correctional-facilities#:~:text=People%20who%20are%20incarcerated%20have%20a%20higher,use%20disorders%20(SUDs)%20than%20the%20general%20population.
2. National Institute on Drug Abuse. (2020). Criminal Justice DrugFacts. Retrieved June 2025 from https://nida.nih.gov/publications/drugfacts/criminal-justice
3. Hill, K., Bodurtha, P.J., Winkelman, T.N.A., & Howell, BA. (2024). Postrelease risk of overdose and all-cause death among persons released from jail or prison: Minnesota, March 2020- December 2021. American Journal of Public Health, 114(9): 913-922. https://doi.org/10.2105/AJPH.2024.307723
| Rank | State |
|---|---|
| 1 | District of Columbia |
| 2 | Massachusetts |
| 3 | Maryland |
| 4 | New Hampshire |
| 5 | New Jersey |
| 6 | New York |
| 7 | Arizona |
| 8 | Maine |
| 9 | New Mexico |
| 10 | Pennsylvania |
| 11 | California |
| 12 | North Dakota |
| 13 | Washington |
| 14 | Colorado |
| 15 | Wisconsin |
| 16 | South Carolina |
| 17 | Nevada |
| 18 | Illinois |
| 19 | West Virginia |
| 20 | Utah |
| 21 | Minnesota |
| 22 | Florida |
| 23 | Oregon |
| 24 | Virginia |
| 25 | Ohio |
| 26 | Michigan |
| 27 | Kentucky |
| 28 | Indiana |
| 29 | Tennessee |
| 30 | South Dakota |
| 31 | North Carolina |
| 32 | Missouri |
| 33 | Georgia |
| 34 | Iowa |
| 35 | Nebraska |
| 36 | Montana |
| 37 | Alabama |
| 38 | Texas |
| 39 | Kansas |
| 40 | Oklahoma |
| 41 | Louisiana |
| 42 | Idaho |
| 43 | Alaska |
| 44 | Wyoming |
| 45 | Arkansas |
| 46 | Mississippi |
| * | Connecticut |
| * | Delaware |
| * | Hawaii |
| * | Rhode Island |
| * | Vermont |
Percent of local jail jurisdictions and facilities that provide overdose reversal medications to detainees with OUD upon release
Studies show that people reentering communities from incarceration are at very high risk of overdose and death for the first two weeks following release.4 Providing people with naloxone is an essential strategy to reduce their immediate risk of death during that time. On average, only 31% of jails reported that they provide overdose reversal medications to detainees with OUD upon release from jail.
4. The Council of State Governments Justice Center & Addiction Policy Forum. (2020). Implementing evidence-based strategies to reduce overdose risk during reentry: A primer for reentry professionals. https://csgjusticecenter.org/wp-content/uploads/2024/10/Implementing-Evidence-Based-Strategies-to-Reduce-Overdose-Risk-During-Reentry_v3_508.pdf
Percent of local jail jurisdictions and facilities that provide a link to MAT in the community to detainees with OUD upon release
On average, 37% of surveyed jails reported that they connected people with OUD to community-based MAT upon release from incarceration. Jails were less likely to provide this connection to care in southern and midwestern states. In Louisiana, Texas, Wyoming, Nebraska, Alabama, Arkansas, Kansas, Oklahoma, and South Dakota, fewer than 10% of jails provided a link to community-based MAT. In Alaska (ranked last), none of the surveyed jails connected people to MAT in the community. Several states ranked in the top 10 for this indicator have created statewide programs to ensure continuity of care upon release from incarceration, including Massachusetts, Maine, and New Jersey.