Dr. Sarah Spencer and Case Supervisor Annette Hubbard see a affected person within the cellular clinic exterior of a shelter in Kenai, Alaska on November 20, 2025.
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Ash Adams for NPR
On the Ninilchik Neighborhood Clinic on Alaska’s rural Kenai peninsula this summer season, Dr. Sarah Spencer stood subsequent to a affected person mendacity on an examination desk, and swiped her stomach with alcohol. The affected person was there for a month-to-month buprenorphine shot to deal with her opioid use dysfunction – a shot she thought is likely to be her final for some time since there was a warrant out for her arrest. The Alaska Division of Corrections doesn’t present complete entry to this life saving remedy.
“I am gonna provide you with a bit pinch,” Spencer mentioned, sliding the needle right into a fold of pores and skin on the affected person’s stomach for the subcutaneous injection.
Alaska’s not an outlier. Even though these lately launched from incarceration are among the most susceptible to dying from drug overdose, dependancy consultants say that many jails and prisons across the nation do not present remedy remedy.
Organizations just like the Ninilchik Neighborhood Clinic say they do what they’ll to deal with individuals going into or popping out of jail or jail, however can not help these inside. And in response to dependancy medication specialists, any interruptions in remedy may make it tougher for individuals to remain in restoration – and survive their opioid dependancy.
“I actually needed to do good”Â
Spencer’s affected person on the clinic that day in August was a girl who requested that NPR use solely her first preliminary, H., as a result of she criticized the Alaska Division of Corrections and she or he was afraid of retaliation from employees in jail. She mentioned she was anticipating to be incarcerated for about 6 months.
H. mentioned there are typically contraband medication in jail, and she or he needed to get these pictures so she had the very best likelihood of staying sober whereas incarcerated.
“I needed to cowl my bases, as a result of I actually, actually needed to do good,” H. mentioned. “I did not need to go backwards.”
Many research have proven that remedy for opioid use dysfunction makes restoration extra doubtless and reduces the chance of overdose loss of life.
If individuals aren’t in a position to get remedy whereas incarcerated, they might relapse in jail on black market medication, or, if they do not use opioids inside, they may detox and their tolerance will go down. That makes them extra prone to overdose after they go away.
“There isn’t a inhabitants that is at greater danger than individuals who have been lately incarcerated and a giant a part of that’s as a result of… it solely takes two weeks for individuals to lose their tolerance to opioids,” Spencer mentioned.
Dr. Sarah Spencer, Peer Assist Specialist Harold Sargeant, and Case Supervisor Annette Hubbard arrange at a location in Nikiski, Alaska on November 20, 2025.
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Analysis backs up the concept that individuals despatched to jails and prisons are extremely susceptible to drug loss of life. Federal information launched by the Biden administration confirmed as much as 1 in 4 overdose deaths nationally in 2021 concerned individuals “lately launched from jail or jail.” And one Nationwide Institute of Well being examine discovered that within the weeks after being launched from jail, individuals had been as much as 40 instances extra prone to die from overdoses in contrast with the final inhabitants.
H. mentioned the remedy for her opioid use dysfunction was interrupted when she was incarcerated earlier in 2025. She mentioned the Alaska Division of Corrections denied her remedy and she or he began utilizing illicit opioids once more when she obtained out.
“It occurs tremendous quick,” H. mentioned. “I did not have a telephone or something, however you run into individuals. You see individuals. It simply – there’s 1,000 alternative ways.”
Limitations on remedy
Interviews with healthcare suppliers like Dr. Spencer and previously incarcerated individuals like H. point out that many who need remedy whereas incarcerated do not get it.
Alaska’s Division of Corrections, or DOC, declined repeated requests for an interview for this story, however they responded to questions over e-mail.
They confirmed that they solely give 30 days of remedy remedy to individuals who had been already getting it earlier than incarceration. Nobody will get remedy for greater than a month, until they’re pregnant. When individuals are launched, DOC mentioned they offer some a listing of suppliers they’ll go to for remedy.
However Spencer mentioned greatest apply is to make it a lot simpler for any inmate to begin and keep on remedy and to offer them with a transition plan – like DOC establishing an appointment for them with a healthcare supplier in the neighborhood – to assist them keep secure after launch.
“If a affected person is not continued on their remedy or is not provided remedy, you are actually lacking that chance to stabilize this life threatening illness whereas they’re in DOC custody,” she mentioned.
Dr. Sarah Spencer and Case Supervisor Annette Hubbard focus on varied circumstances between sufferers. When not seeing sufferers within the cellular clinic, each spend their time on the telephone and laptop – following up with sufferers, connecting them with sources, and fielding questions.
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DOC mentioned their goal is to increase entry to remedy for opioid use dysfunction, they usually hope to pilot a extra complete program by February of 2026.
Spencer mentioned within the absence of complete remedy, her group tries their greatest to offer take care of individuals earlier than and after incarceration, a minimum of on the Kenai peninsula.
Her colleague Annette Hubbard is a case supervisor who routinely checks the court docket docket for energetic warrants – and helps those that she is aware of have opioid use dysfunction get remedy earlier than they go in.
“I try this voluntarily, as a result of I do know that the those who I work with and for are at all times in danger,” Hubbard mentioned.
A contrasting strategy in Rhode IslandÂ
Spencer mentioned she needs Alaska’s system had been extra like Rhode Island’s. In 2016, the state began providing remedy for substance use problems to anybody eligible in DOC care. Inside a yr, there had been a 61% discount in overdose loss of life charges amongst individuals lately incarcerated, and a 12% discount in overdose deaths statewide.
Dr. Jennifer Clarke developed this system as medical director on the Rhode Island Division of Corrections.
Earlier than she may freely dispense remedy for substance use problems, she mentioned, “it was like working towards medication with one hand tied behind my again.”
In keeping with Clarke, the outcomes of the brand new program had been palpable: when individuals weren’t going by means of withdrawal and having cravings, they may focus higher on restoration.
“I heard a number of instances, individuals would inform me, ‘This was the primary time I may actually take part within the remedy lessons, within the behavioral remedy,'” Clarke mentioned.
However she mentioned it wasn’t at all times straightforward. This system required two million {dollars} in funding to begin, the backing of the then-governor, and it needed to overcome many logistical hurdles. And she or he mentioned, there was stigma.
“I used to be known as regularly a drug pusher,” she mentioned. “So with the medical employees, I might simply discuss information. I am like, ‘We’re scientists… We will observe the science.'”
Throughout the nation, inconsistent entry to care
Different states have been sluggish to develop comparable life-saving remedy packages. In a latest examine revealed in JAMA Community Open, consultant of over 3,000 U.S. jails, fewer than half provided some entry to remedy for opioid use dysfunction.
Redonna Chandler, a psychologist previously on the Nationwide Institute on Drug Abuse, mentioned remedy will be onerous to entry for anybody with opioid use dysfunction, and infrequently jails and prisons do not have suppliers with the experience needed to offer the medicines.
“I feel it is nonetheless a patchwork of packages,” Chandler mentioned.
And since medicines like buprenorphine are opioids themselves and assist alleviate signs of withdrawal, there are black markets for them inside jails and prisons.
Case Supervisor Annette Hubbard holds a field of Naloxene injections that she says the clinic receives from the Treatment Alliance.
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Ash Adams for NPR
“You may hear numerous issues about ‘diversion’ and about tablets being diverted, however there are methods to cope with and get round that, both by means of different formulations or by means of the methods in which you’d administer the remedy,” Chandler mentioned. That might imply shifting from tablets to injectable formulations, that are a lot tougher to divert.
Within the meantime, some sufferers like H. in Ninilchik might solely be capable to get remedy exterior incarceration.
“It will simply be so large to have the ability to get it in jail too, after which acquire that power to have the ability to assist your self whenever you did hit the streets once more,” H. mentioned.
It is unclear when she is going to begin her new jail sentence, however she mentioned she hoped when she obtained out, she’d go proper again to remedy. If she does, it could save her life.
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