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 offer you somewhat 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. Although these lately launched from incarceration are a number of the most weak to dying from drug overdose, dependancy consultants say that many jails and prisons across the nation do not present remedy therapy.
Organizations just like the Ninilchik Neighborhood Clinic say they do what they will to deal with individuals going into or popping out of jail or jail, however can not help these inside. And in accordance with dependancy drugs specialists, any interruptions in therapy may make it more durable for individuals to remain in restoration – and survive their opioid dependancy.
“I actually wished to do good”
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 wished to get these photographs so she had one of the best probability of staying sober whereas incarcerated.
“I wished to cowl my bases, as a result of I actually, actually wished to do good,” H. mentioned. “I did not wish to go backwards.”
Many research have proven that remedy for opioid use dysfunction makes restoration extra possible and reduces the danger of overdose demise.
If individuals aren’t capable of get remedy whereas incarcerated, they might relapse in jail on black market medicationor, if they do not use opioids inside, they’ll detox and their tolerance will go down. That makes them extra inclined to overdose after they go away.
“There isn’t a inhabitants that is at larger 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 weak to drug demise. 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 research discovered that within the weeks after being launched from jail, individuals have been as much as 40 occasions extra more likely to die from overdoses in contrast with the final inhabitants.
H. mentioned the therapy 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 received 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 other ways.”
Limitations on therapy
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 therapy to individuals who have been already getting it earlier than incarceration. Nobody will get therapy for greater than a month, until they’re pregnant. When individuals are launched, DOC mentioned they provide some an inventory of suppliers they will go to for therapy.
However Spencer mentioned finest observe is to make it a lot simpler for any inmate to begin and keep on remedy and to supply them with a transition plan – like DOC establishing an appointment for them with a healthcare supplier locally – 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 instances between sufferers. When not seeing sufferers within the cellular clinic, each spend their time on the telephone and pc – following up with sufferers, connecting them with sources, and fielding questions.
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DOC mentioned their intention is to develop 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 therapy, her staff tries their finest to supply take care of individuals earlier than and after incarceration, no less than on the Kenai peninsula.
Her colleague Annette Hubbard is a case supervisor who routinely checks the courtroom docket for energetic warrants – and helps those that she is aware of have opioid use dysfunction get therapy earlier than they go in.
“I do this voluntarily, as a result of I do know that the those who I work with and for are all the time in danger,” Hubbard mentioned.
A contrasting strategy in Rhode Island
Spencer mentioned she needs Alaska’s system have been extra like Rhode Island’s. In 2016, the state began providing therapy for substance use issues to anybody eligible in DOC care. Inside a yr, there had been a 61% discount in overdose demise 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 issues, she mentioned, “it was like working towards drugs with one hand tied behind my again.”
In line with Clarke, the outcomes of the brand new program have been palpable: when individuals weren’t going via withdrawal and having cravings, they may focus higher on restoration.
“I heard a number of occasions, individuals would inform me, ‘This was the primary time I may actually take part within the therapy courses, within the behavioral remedy,'” Clarke mentioned.
However she mentioned it wasn’t all the time 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 he or she mentioned, there was stigma.
“I used to be referred to as continuously a drug pusher,” she mentioned. “So with the medical employees, I’d simply discuss information. I am like, ‘We’re scientists… We’ll comply with the science.'”
Throughout the nation, inconsistent entry to care
Different states have been sluggish to develop comparable life-saving remedy packages. In a latest research revealed in JAMA Community Openconsultant of over 3,000 U.S. jails, fewer than half provided some entry to remedy for opioid use dysfunction.
Redonna Chandlera psychologist previously on the Nationwide Institute on Drug Abuse, mentioned remedy will be laborious to entry for anybody with opioid use dysfunction, and infrequently jails and prisons do not have suppliers with the experience obligatory 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 will hear numerous considerations about ‘diversion’ and about capsules being diverted, however there are methods to cope with and get round that, both via different formulations or via the methods in which you’d administer the remedy,” Chandler mentioned. That would imply shifting from capsules to injectable formulationsthat are a lot more durable to divert.
Within the meantime, some sufferers like H. in Ninilchik might solely have the ability to get therapy exterior incarceration.
“It could simply be so large to have the ability to get it in jail too, after which acquire that energy to have the ability to assist your self whenever you did hit the streets once more,” H. mentioned.
It is unclear when she’s going to begin her new jail sentence, however she mentioned she hoped when she received out, she’d go proper again to therapy. If she does, it could save her life.
