Published: 08/21/2026 | Author: Quentin Blount

Colorado told its county jails four years ago to provide medications for opioid use disorder and to publish their policies for doing it. A review of all 46 county jails in the state found that nearly 40 percent still have no publicly available policy explaining how they deliver opioid addiction treatment.

The study, from researchers at the University of Colorado Anschutz Medical Campus, was published in the journal Health and Justice. It matters because the days after release from jail carry one of the highest overdose risks in the opioid crisis.

What the Researchers Found

The team reviewed opioid treatment policies from every county jail in Colorado, collecting publicly available documents and information provided directly by jails between June and October 2024.

Among the 28 jails that provided policy information:

• 71 percent described screening individuals for substance use disorder
• 67 percent outlined policies for providing medications for opioid use disorder
• 63 percent described connecting people with treatment after release
• 46 percent indicated they offered all three FDA-approved medications for opioid use disorder
• 26 percent included peer recovery support services
• 22 percent described harm reduction services such as providing naloxone upon release

Fewer than half of the jails with policies indicated they offered all three approved medications, so access can depend on which medication a person was stabilized on before arrest.

The researchers were explicit about a limitation, and it should not be skipped. The study evaluated written policies, not actual clinical practice. Some jails may provide services that their public documents do not reflect. What the study measures is transparency, and the researchers argue transparency is itself necessary for continuity of care.

State Law Behind the Mandate

Colorado’s Fentanyl Accountability and Prevention Act, passed in 2022, requires county jails to develop and publish opioid treatment policies, to offer medications for opioid use disorder to eligible individuals, and to help connect people with treatment after release.

Katherine LeMasters, PhD, MPH, senior author of the study and assistant professor of medicine at CU Anschutz and the Colorado School of Public Health, said legislation is an important first step but that policies also need to be transparent, comprehensive, and consistently implemented.

Publicly available policies, she noted, help clinicians, families, and community organizations support people during incarceration and after release.

Why Rural Counties Lag

The study found urban jails were generally more likely than rural jails to have comprehensive policies for screening, addiction treatment, and post-release care. Rural jails often faced limited access to opioid treatment programs and other community resources.

There is a structural reason. Methadone must be dispensed through federally regulated and state-licensed opioid treatment programs, which makes access difficult where no such program exists nearby.

LeMasters pointed to sustainable funding, technical assistance, and partnerships with community providers as what would be needed to implement the law fully.

Understanding the Medications

Three medications are approved in the US for opioid use disorder. Methadone and buprenorphine are opioid agonists that occupy opioid receptors, which relieves withdrawal and cravings without producing the effects sought in misuse.

Extended-release naltrexone is an opioid antagonist that blocks those receptors and is started after withdrawal is complete. Research has shown these medications reduce overdose deaths, improve recovery, and lower the likelihood of returning to jail.

Naloxone is different. It is not a treatment but an emergency medication that reverses an opioid overdose in progress, and it is the reason the 22 percent figure above carries weight.

What Happens Without Medication

Without medication, people going through opioid withdrawal in custody can experience severe physical symptoms and intense cravings, which raises the risk of returning to opioid use after release. As LeMasters put it, people may go through painful withdrawal in custody, and after release that can increase the risk of returning to use, overdose, and death.

The mechanism is tolerance. Weeks without opioids lower it sharply, so a previously manageable dose can be fatal, and with fentanyl dominating the illicit supply the margin is smaller still.

Harm Reduction and Treatment After Release

For anyone leaving jail, or supporting someone who is, the first days matter most:

• Get naloxone before release if the facility provides it, or immediately after from a pharmacy or a community harm reduction program. Colorado pharmacies can dispense it under a standing order.
• Ask the facility to arrange a medication appointment before the release date, not after. Gaps are where overdoses happen.
• If someone was on methadone or buprenorphine before incarceration, ask specifically whether the jail will continue it and whether the previous clinic can resume treatment on release.
• Fentanyl test strips are legal in Colorado and available through harm reduction organizations.

Finding Help for Opioid Addiction

Peer support fills the gap that clinical appointments cannot. Narcotics Anonymous meetings run throughout Colorado, in Denver, Colorado Springs, Aurora, Pueblo, Fort Collins, and smaller communities, including virtual meetings for people without transportation. NA is one path among several, and it works alongside medication rather than instead of it.

Narcotics.com maintains a nationwide NA meeting directory searchable by state and city, with filters for meeting type, language, and format. For opioid treatment programs and referrals, call 800-934-1582(Sponsored) to receive help identifying options near you.