DOJ Guidance Ignored: ADA Protection & Medications for Opioid Use Disorder Treatment in Corrections

Highlighted Stories

Editor's Note

In the Weekly Update, there have been many Editor’s Notes on the subject of Medications for Opioid Use Disorder (MOUD) in correctional settings. Much of what COCHS has written on the issue has boiled down to a familiar but still important point: medications for opioid use disorder work. Yet despite the growing evidence, resistance to MOUD remains common in correctional environments—driven by stigma, abstinence-only philosophies, limited provider training, budget constraints and fear of diversion. This resistance persists even though, in 2022, the Department of Justice issued guidance explaining that people with opioid use disorder who are in treatment or recovery, including those taking medication for OUD, are protected under the Americans with Disabilities Act.

This week's first highlighted article reinforces what research has consistently shown about both the efficacy of MOUD and the persistence of resistance to these treatments in correctional settings, but it also adds something more useful: a geographic breakdown of how MOUD is actually being used in correctional facilities. According to the survey, only 58% of facilities offer at least one FDA-approved medication for opioid use disorder. The West reports the highest rates of availability, while facilities in the South, Midwest, and rural areas report the greatest uncertainty about care delivery. Another notable finding is that MOUD is more common in jails than in prisons. That difference may reflect jails' closer ties to local communities and health systems, but it also underscores how uneven correctional treatment remains depending on where one is incarcerated. Interestingly, when discussing resistance to MOUD, the article does not mention the DOJ's ADA guidance and the protections it may afford (see Editor's Note of April 2, 2024).

The second article, from Medical Express, complicates the picture further. The issue is not only whether MOUD is available, but whether it is being dosed adequately and equitably. Higher doses of buprenorphine were associated with significantly better treatment adherence, yet Black patients were less likely than white patients to receive those higher, more effective doses. So even when treatment is technically available, important questions remain about whether it is being delivered in a way that reflects current evidence and basic fairness.

The third and final highlighted article introduces another troubling dimension. Up to this point, much of the conversation has centered on opioids and their treatment. But The New York Times reports on a rapidly shifting synthetic drug market that now includes not only fentanyl, but also powerful tranquilizers, stimulants, nitazenes, and synthetic cannabinoids. These substances are more potent, more unpredictable, and harder to detect. They are also driving sharp increases in overdoses and deaths, including in correctional settings.

Taken together, these articles suggest that correctional systems are still struggling to provide consistent, evidence-based treatment for opioid use disorder even as the drug environment becomes more synthetic, more volatile, and more deadly. If treatment in correctional healthcare remains this uneven while the illicit supply continues to evolve this quickly, the gap between what is needed and what is being delivered could widen dramatically.

Returning, then, to DOJ guidance and to COCHS’ long-standing emphasis on bringing Medicaid into correctional environments: in an October 1, 2024 Editor’s Note, COCHS suggested that Medicaid’s status as an entitlement especially in light of the many 1115 waivers that have been approved, may create rights under the Fourteenth Amendment that could help address correctional intransigence toward MOUD—the very resistance identified in this week’s first highlighted article. To quote from that earlier note: “COCHS is once again suggesting that, with the 1115 waivers that permit Medicaid behind the wall and Sections 5121 and 5122 of the Consolidated Appropriations Act of 2023, individual Medicaid beneficiaries may have statutory and constitutional rights to challenge the failure to receive care, no matter the moral judgment a carceral system has about SUD. Subjective moral opprobrium does not create a barrier to an individual’s rights under the 14th Amendment.”

MOUD In Corrections

Pharmaceuticals Inc. announced results from a cross-sectional survey published in the Journal of Correctional Health Care that reveal critical gaps in the availability of medications for opioid use disorder (MOUD) across U.S. correctional facilities. The study found that jails were more than twice as likely to provide MOUD compared to prisons and that facilities in the West had over three-fold higher odds of offering MOUD than those in the Midwest. Regional disparities persist, with facilities in the South, Midwest and rural areas reporting the greatest uncertainty about care delivery. Many facilities cited persistent barriers to implementation, including stigma, abstinence-only philosophies, lack of provider training, limited budgets, and geographic disparities in healthcare infrastructure.

Buprenorphine

Patients who are prescribed higher daily doses of the medication buprenorphine for opioid use disorder are significantly more likely to stay in treatment. Those on 17 to 24 milligrams averaged 190 days in care compared to 90 days for those on 8 milligrams or less. Yet Black patients are less likely than white patients to receive the higher doses.

Synthetic Drugs

For months, inmates had been falling ill at the Cook County jail in Chicago. Today, fringe chemists are ushering in a total transformation of the illicit drug market. Operating from clandestine labs, they are churning out a dizzying array of synthetic drugs — not only fentanyl, but also hazardous new tranquilizers, stimulants and complex cannabinoids. The consequences are severe: higher risks of respiratory suppression, psychosis, violence, overdose and death. Nitazenes, a class of synthetic opioid that killed one of the inmates at the Cook County jail, can be 20 times more potent than fentanyl

Follow Ups

Wellpath

Editor's Comment: Oh boy, this week's first Follow Up certainly caught our attention! Once again, it involves Wellpath — and no, not about its bankruptcy. Something far more telling.

An attorney in Charleston County, South Carolina, representing a detainee in a malpractice suit is seeking to subpoena the personal finances of the County Administrator and Procurement Director in connection with the county's 2020 contract with Wellpath. Attorney Gedney M. Howe stopped short of stating outright that he was alleging impropriety — but the implication was hard to miss.

On that note, we would remind our subscribers that when Wellpath operated under the name Correct Care Solutions (CCS), its former CEO, Gerard Boyle, and Bob McCabe, sheriff of Norfolk County, Virginia, were convicted on felony bribery charges related to jail medical services. A few weeks ago, when discussing the revolving names of YesCare/Corizon/Tehum Care, we jokingly said that company had more name changes than someone in witness protection. Well, it seems CCS/Wellpath/CFMG may be ready to join them there. For those who do not know their correctional healthcare vendor history, CFMG, California Forensic Medical Group, and CCS merged in 2018 to form Wellpath, owned by private equity firm, HIG Capital).

Subscribers may also want to check out how VitalCore's tenure in Charleston is going — see the final article at the end of this Weekly Update.

Two Charleston County officials are trying to fend off subpoenas seeking their personal finances as part of a jail detainee’s medical malpractice lawsuit, according to a new federal court filing. Attorney Gedney M. Howe IV is demanding that County Administrator Bill Tuten and Procurement Director Barrett Tolbert turn over five years of personal finances in connection with a contract for a jail medical provider (Wellpath) in 2020. Howe does not specifically state in the filing why he needs the financial records, and he did directly answer a question from a reporter as to whether he was suggesting something improper had occurred. He said only that he was “investigating it.” Howe justified the subpoenas in citing depositions from current and former jail officials as well as a trove of emails released by the sheriff’s office in 2023. Those exchanges, he believes, raise questions about the legitimacy of the contract, how much due diligence the county actually did about Wellpath. The county paid Wellpath around $6 million annually.

California

Editor's Comment: In the Editor’s Note of March 10, 2026, we specifically mentioned the high number of in-custody deaths in both Los Angeles County and San Diego County. The two stories below show that these fatalities continue to shape both systems, though in different ways. In Los Angeles County, the sheriff is seeking assistance from the National Institute of Corrections to examine conditions in the jail. This follows the lawsuit filed by the California Attorney General in September 2025 alleging unconstitutional conditions. In San Diego, lawsuits claim that a pattern and practice within the jail led to the death of a detainee.

These developments also connect back to another Editor’s Note, from March 3, 2026, in which we discussed Assemblymember Gregg Hart’s AB 2257. That bill would allow counties to continue with sheriff-operated jails or appoint an alternative official to oversee operations when improved administration is needed. One impetus for such legislation is the familiar situation in which counties bear the financial consequences of poor outcomes—costs that can strain budgets and divert resources from other services.

Sheriff Robert Luna has asked the National Institute of Corrections to examine conditions and practices at Los Angeles County jails, a request made after 10 inmates died in jail custody in less than three months. The request comes amid growing concern over conditions inside county lockups. In September, California Atty. Gen. Rob Bonta sued the Sheriff’s Department over what he called “unsafe and unconstitutional conditions at county jails.” According to department data, half of the 46 inmate deaths recorded in 2025 were listed as natural. Autopsy results to determine the causes of death are still pending in this year’s cases.

The lawsuit argues that at the time of Abdul Kamara's death, there was a pattern and practice of San Diego County sheriff's deputies taking people in crisis to jail instead of a hospital. A federal judge this week declined a request by county attorneys to dismiss a lawsuit filed by the mother of 29-year-old Abdul Kamara, who died March 4, 2024, hours after being placed in a restraint device at the Vista jail. U.S. District Judge Anthony Battaglia ruled that the lawsuit, filed last year by Fredrika Nabbie, provides enough evidence to allege that failures by San Diego County sheriff’s deputies led to Kamara’s death.

New York

Editor's Comment: In the March 10 New York Follow Up, we began to see how New York’s prison system may be becoming a political football in this year’s gubernatorial race. Are the first two stories below early signs of that? Democratic Senator Julia Salazar has introduced a bill that would subject correctional officers to the same screening requirements as visitors in an effort to reduce contraband. Meanwhile, Republicans are seeking to revise the Humane Alternatives to Long-Term Solitary Confinement (HALT) Act by expanding the use of solitary confinement. Gov. Hochul, for her part, has said she is committed to making the prison system safer for both incarcerated people and staff.

The final article, from The New York Times, offers an interesting detail about a provision in the HALT Act that we had not previously been aware of: legal representation is permitted at disciplinary hearings, even when that representation is provided by another incarcerated person. The article describes one incarcerated man who has taken on that role and, in doing so, has cross-examined the very guards who oversee him.

Corrections officers would face random screening with full-body scanners before entering New York’s state prisons under legislation proposed this week at the state Capitol. State Sen. Julia Salazar, a Brooklyn Democrat who is sponsoring the bill, said subjecting guards to the same screening required of visitors would reduce contraband in correctional facilities. Republicans in Albany this week introduced legislation sought by the corrections department in the aftermath of the strike; it would partially roll back a 2021 law that restricted the use of solitary confinement in prisons. The pair of bills shows how the prison system remains a source of frustration for lawmakers in both parties. Gov. Kathy Hochul, a Democrat, has said she is committed to making the prison system safe for incarcerated people and staff.

New York Assembly Republicans announced legislation addressing staffing and safety concerns inside New York's prisons, tied to fallout from the 2025 corrections officer strike. The bill, A.10430, incorporates 10 recommendations from the state's Humane Alternatives to Long-Term Solitary Confinement (HALT) Committee and seeks to revise portions of the HALT Act by expanding the types of behavior eligible for segregated confinement; clarifying that individuals involved in riots may be placed in segregated confinement; allowing short-term disciplinary confinement for repeat misconduct; permitting short-term protective custody in segregated settings when no safe alternative exists; and providing the Department of Corrections and Community Supervision greater flexibility in managing individuals who pose ongoing safety risks.

Quentin Lewis is an incarcerated "jailhouse lawyer" at Wende Correctional Facility in Western New York who provides legal assistance to fellow inmates. Mr. Lewis’s legal role has recently expanded to a new area of practice: representing inmates accused of breaking the rules at Wende. Traditionally in New York State, an inmate accused of fighting, possessing contraband or any number of violations was often on his own at a disciplinary hearing. But a state law that took effect four years ago now allows legal representation at these prison tribunals — even from fellow inmates. This was a lesser-known provision of the HALT act, known for reforming the use of solitary confinement. Mr. Lewis regularly finds himself cross-examining the very prison guards who oversee him.

Mental Health

There were six confirmed or apparent suicides of incarcerated men in Massachusetts prisons last year — a surge that broke from several years of lower numbers and occurred while under U.S. Department of Justice monitoring. Half the suicides last year occurred in in MCI-Norfolk’s behavioral assessment unit (BAU). These units the DOC created four years ago that critics compare to solitary confinement. DOC Commissioner Shawn Jenkins emphasized that they are not punitive units and are distinct from restrictive housing.

The Massachusetts Department of Correction today announced a comprehensive set of actions it will take to strengthen suicide prevention, clinical coordination, and safety operations across the correctional system. The Department is implementing several recommendations immediately and continuing to evaluate others as part of a systemwide effort to improve risk identification and strengthen continuity of care. Recent initiatives include the launch of an overnight mental health wellness helpline and a multi-pronged strategy to combat the prevalence of K2 and other dangerous contraband that pose mental health risks in correctional settings nationwide.

Being incarcerated is depressing in and of itself, but it is often is wise to have this patient evaluated for something more. There are medical conditions that can lead to lack of appetite and insomnia that need to be ruled out. In addition, this patient might have a mood disorder. Mood disorders are alterations in emotions that are expressed as depression, mania or both. They interfere with a person’s life, troubling him or her with severe long-term sadness, agitation, or elation. The accompanying guilt, anger, self-doubt leads to altered life activities and relationships.

ICE

From the moment they were arrested, women interviewed by The Times said, ICE agents appeared unconcerned with the fact that they were pregnant. In five cases identified by The Times, ICE agents cuffed a pregnant woman’s hands and ankles, even after learning about their pregnancies, according to the women, their lawyers, their family members and legal briefs. Two said the agents wrapped chains around their bellies, refusing to remove them even after one woman began bleeding on the airplane bound for a detention center.

A 19-year-old Mexican migrant died at a county jail in Florida that has been holding immigrant detainees, according to U.S. Immigration and Customs Enforcement. According to ICE, Royer Perez-Jimenez "died of presumed suicide," although an official cause of death remains under investigation. The Mexican government said Thursday in a statement that such immigration detention deaths are "unacceptable" and called for a prompt and thorough U.S. investigation to prevent a recurrence. Florida is one of the states that aligns most with the Trump administration on immigration matters and houses some of the most well-known immigrant detention centers, such as the South Florida Detention Facility, also known as Alligator Alcatraz, and Krome North Service Processing Center.

CGL Irwin Properties LLC must face a federal lawsuit alleging that immigrant detainees at a Georgia detention center were forced to work for as little as $1 a day. U.S. District Judge W. Louis Sands rejected the company's attempts to dismiss the case, ruling that it was properly and timely served, allowing the lawsuit—originally filed in March 2023—to move forward.

Stephan Crétier, 62, who has an estimated net worth of between $2.6 billion and $4.6 billion, runs GardaWorld Federal Services, which was awarded a massive contract to manage a forthcoming migrant detention warehouse in Arizona by the Trump administration. He was accused of making death threats against his employees and their families if they told anyone about his company’s alleged financial troubles. GardaWorld provides guard services at Florida’s “Alligator Alcatraz” complex—which has faced intense backlash over inhumane conditions—but has no experience of managing detention facilities.

GEO Group told its investors that ICE contracts account for 43 percent of its revenue. CoreCivic — GEO’s chief rival pegs its ICE share at 30 percent. Together, the two companies are worth roughly six billion dollars. The loyist who protect that money work on K Street. The day after Donald Trump won reelection, GEO’s stock jumped 41 percent. CoreCivic’s went up 29. Below GEO and CoreCivic, the industry runs deeper still. Management & Training Corp — MTC — runs the Otero County Processing Center in New Mexico and spent $630,000 on federal lobbying in 2024, with eight lobbyists working its account, three of them fresh off government jobs. Then there is LaSalle Management, which owns immigration detention centers across the South and whose Irwin County Detention Center in Ocilla, Georgia became the site of accusations that a doctor performed coerced hysterectomies on detained women.

The Enforcement and Removal Operations unit of Immigration and Customs Enforcement oversees the nation's immigration detention facilities, often contracting operations to private companies. While the federal government and its chosen contractors are responsible for nutrition, hygiene, and safety in civil immigration detention, watchdog organizations say oversight mechanisms designed to catch abuses and poor conditions have been weakened under the Trump administration. In early 2025, the administration rolled back operations at two agencies that had played key roles in investigating civil rights violations by DHS and monitoring detention conditions. Over the past year, the nonprofit newsroom the Project on Government Oversight and American University found that even as detention soared in 2025, inspections by ICE’s Office of Detention Oversight dropped by 36.25% It is in this environment that Management & Training Corporation is set to open a detention center in Marana, Arizona, despite significant community opposition.

Reforming Corrections

Ninety-five percent of people who are incarcerated in the United States will eventually be released. How they’re treated while behind bars profoundly affects their chances of success on the outside. Over the past decade, some states have begun to rethink the ways their prisons work, making prison life safer for incarcerated individuals and staff. In Chester, Pa., for example, the State Correctional Institution established a unit to test a more humane approach to incarceration. The people in this unit experience more autonomy and a living space that better reflects spaces on the outside — an exercise area, a game table, access to a kitchen and more. States are also taking aim at one of the key challenges facing people upon release from prison: the ability to find and maintain employment.

Prisons in the Unites States are rife with violence and not set up to address the underlying circumstances that can lead to criminal justice involvement, like addiction and lack of jobs, healthcare, and education. But incarceration doesn’t have to be that way. Some of the reforms in this report focus on improving living conditions and reducing violence in prison. Others are aimed at improving health and staff resources for corrections or increasing education and vocational opportunities. Changes are happening all over the country, in jurisdictions as varied as Arizona, California, Colorado, Connecticut, Idaho, Indiana, Maine, Massachusetts, Missouri, North Dakota, Oklahoma, Oregon, Pennsylvania, South Carolina, and Washington.

In recognition of National Agriculture Month, the El Paso County Sheriff’s Office Jail-Based Behavioral Services (JBBS) program and the local 4-H chapter have launched their flagship collaboration: the Cultivating Change: Agriculture and Mental Health Initiative. This program connects local 4-H youth with incarcerated individuals at the El Paso County Jail through agricultural education, mental health awareness, and creative expression. Youth from the Country Style 4-H Club developed presentations highlighting agriculture’s vital role in daily life and various career pathways across Colorado. These materials, which included messages of encouragement, were delivered via structured workshops facilitated through the JBBS program.

Nutrition & Food

While many rehabilitative gardening and farming programs focus on education, food justice, and reduced recidivism, it is important to acknowledge the larger landscape of prison labor. By some estimates, roughly 30,000 incarcerated individuals work in farming or other food-related jobs. In many cases, these jobs are not part of rehabilitative programs, pay little to nothing, and the food produced may not benefit those doing the work — a direct echo of the slave labor legacy that built America's economic and political capital. Understanding this broader context helps illuminate the difference between exploitative labor practices and rehabilitation-focused agriculture programs.

Lawmakers are considering a wide-ranging bill designed to address health care and nutrition in Connecticut prisons after multiple government reports exposed problems with medication distribution, staffing levels, food quality and medical care within Department of Correction facilities. The bill also follows a recent report from the state Correction Ombuds that detailed unsanitary living conditions, a lack of nutritional food, delays in necessary medical care and staffing shortages that regularly confined incarcerated people to their cells.

State Roundup

California

By the time Gov. Gavin Newsom leaves office, California will have five fewer state prisons than when he came into power. Some California state lawmakers want to make it six. They’re pointing to a new analysis that shows the state’s incarcerated population has fallen so dramatically that California can close another prison and still have capacity for the 90,000 or so people presently locked up.

Montana

Montana has a problem — not crime, but a prison addiction. The state is spending nearly $900 million to build new prisons and jails, expand existing facilities, and establish a forensic health facility. However, the best crime prevention program is education. Few people in prison have a college degree. It costs far less to educate someone than to incarcerate them. Today, a Montana resident's tuition for one year at the University of Montana averages around $3,000. Prison? $40,000.

Pennsylvania

A lawsuit filed by Disability Rights Pennsylvania says that the state’s prison system restricts access to insulin pumps and glucose monitors, putting people with Type 1 diabetes at risk of death or serious injuries. Even though Type 1 diabetes is classified as a disability under the Americans with Disabilities Act, many incarcerated people are deprived of the care they need, with catastrophic consequences. Earlier this month, a Philadelphia jury ordered the city to pay $1.5 million to the family of a man with Type 1 diabetes who died after he was deprived of insulin

Texas

The county has been sending inmates out of state for more than a decade due to overcrowding and understaffing at the Harris County Jail downtown, which houses an average of roughly 8,400 inmates daily. The new contract, which will last through April 2027, was unanimously approved. Despite a 12% drop in the jail's average population in the last year, the county is still paying LaSalle Corrections to house roughly 1,050 inmates at privately-run jails in Natchitoches and Olla in central Louisiana, a more than four-hour drive from Houston. Three Harris County inmates have died since 2022 at the LaSalle Correctional Center in Olla, where the county is currently outsourcing roughly 640 inmates.

The Dallas County Jail has seen a double-digit increase in deaths under Sheriff Marian Brown and wrongful death lawsuits are piling up. Most people in jail have not been convicted of a crime, and the conditions of the jail are a community concern. Three medical experts pointed to an alarming trend of likely avoidable fatalities since 2018 that autopsies and state in-custody death reports attributed to accidental, natural and undetermined causes, including: Five deaths from blood clots in the lung, which typically have warning signs and are often treatable when addressed.

Correctional Health Care Vendors

WellPath

A third former custody officer at a state-contracted psychiatric hospital in two months was charged with abuse of a vulnerable adult. Authorities charged Columbia resident Vernon Leon Stewart, 62, in an investigation requested by Wellpath Recovery Solutions. T.at’s a contracted provider for the S.C. Department of Behavioral Health and Developmental Disabilities’ Office of Mental Health. The Nashville, Tenn.-based Wellpath previously provided psychiatric services in jails in the Lowcountry but declared bankruptcy in 2024 amid a slew of lawsuits both in the state and around the country.

A medical services provider that filed for bankruptcy in 2024 cannot be sued by the family of a woman who died after an alleged drug overdose at the Lane County Jail, a judge ruled Friday, March 13. U.S. District Judge Ann Aiken dismissed health care company Wellpath LLC from a lawsuit still moving forward against Lane County, after the death of 59-year-old Barbara Stillwell in Feb. 2023. The county last August asked for a judge to order Wellpath to “defend and indemnify” the Lane County defendants — in other words, to defend the county against Stillwell’s lawsuit and compensate it for any damages that might be awarded.

VitalCore

Mary Brucato, a Ladson resident, died on or before Aug. 11, 2025, while suffering from fentanyl withdrawal for about two and a half days inside the Sheriff Al Cannon Detention Center. It was an avoidable death from dehydration, Mark Peper, an attorney for Brucato’s family, has said. At issue is the lack of substantive medical records about care provided to Brucato. She was admitted into the jail on Aug. 8 for possessing fentanyl. The filing accuses VitalCore, the correctional care provider, and its employees of not providing withdrawal monitoring and prescriptions after an initial jail intake flagged her condition. The lack of documentation about her care and who provided it represents “a complete abandonment of basic medical monitoring,” according to the court filing.