Expanding access to medications for opioid use disorder in the criminal legal system beyond prisons and jails

• Pages: 1213-1227
• Date: 01 October 2025
• Published date: 01 October 2025
• Author: Joseph K. Longley

EXPANDING ACCESS TO MEDICATIONS FOR OPIOID USE

DISORDER IN THE CRIMINAL LEGAL SYSTEM BEYOND

PRISONS AND JAILS

Joseph K. Longley*

ABSTRACT

Medications for Opioid Use Disorder (MOUD) are proven to save lives. Yet,

too often, people who have contact with the criminal justice system are prohib-

ited from accessing this lifesaving medical care. Such prohibitions on effective

healthcare would be unimaginable if prison or probation off‌icers were denying

people with diabetes access to insulin. But because of the stigma facing people

with opioid use disorder (OUD), MOUD is routinely denied. Recent litigation

and policy efforts have increased access to MOUD in jails and prison. This

Article argues that this litigation and policy strategy needs to be expanded

throughout the criminal justice system, including to people under court supervi-

sion like probation and parole.

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1214

I. THE CURRENT STATE OF THE OVERDOSE CRISIS . . . . . . . . . . . . . . . . 1215

A. The Heavy Toll of Fatal Overdoses . . . . . . . . . . . . . . . . . . . . . 1215

B. MOUD is the Standard of Care for Opioid Use Disorder, Saves Lives,

and is Underutilized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1215

C. The Lethal Results of Denying Care to People with OUD in the

Criminal Justice System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1217

D. Barriers to Treatment in Non-carceral Criminal Justice Settings. . . 1219

E. Momentum for Policy Change . . . . . . . . . . . . . . . . . . . . . . . . 1220

II. LITIGATION AGAINST JAILS AND PRISONS FOR DENIAL OF MOUD . . . 1220

A. Eighth Amendment Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1221

B. The Americans with Disabilities Act . . . . . . . . . . . . . . . . . . . . 1222

C. DOJ Enforcement Actions Against Probation, Parole, and Drug

Court Entities that Discriminate Against People Who Use

MOUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1224

D. Less Encouraging Efforts Outside of DOJ’s Actions . . . . . . . . . 1225

CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1227

* J.D. 2019, Harvard Law School. The author thanks Regina LaBelle, Shelly Weizman, Allie Frankel, and

Zoe Brennan-Krohn for their thoughts and comments. © 2025, Joey Longley.

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