North Carolina’s prisons have expanded medications for opioid use disorder (MOUD) to people nearing release, addressing a critical overdose risk window. Research shows that formerly incarcerated people are 40 times more likely to die of an opioid overdose within the first two weeks after leaving prison than the average person, according to a North Carolina study cited by Evan Ashkin, a family physician and director of the North Carolina Formerly Incarcerated Transition Program.
Program Expansion and Scale
Nearly 80 percent of people entering North Carolina state prisons need treatment for substance use disorder, according to the N.C. Department of Adult Correction. The agency launched a reentry MOUD program in 2021 at two facilities and has expanded to 24 facilities—about half of the state’s prisons—as of this year. In the past 12 months, more than a thousand incarcerated people received these medications before release, according to Arthur Campbell, chief medical officer at the Department of Adult Correction.
The FDA has approved three medications (buprenorphine, methadone, and naltrexone) to treat opioid use disorder. Research shows that providing these medications in correctional settings decreases opioid use, reduces infectious disease spread, results in less criminal activity after release, and curbs overdoses post-release.
Treatment Process and Outcomes
Approximately 45 to 60 days before release, program staff begin accepting referrals. Eligible participants receive oral buprenorphine followed by a long-acting buprenorphine injection (Brixadi) three to five days before release. The medication costs average about $1,800 per person, with each injection lasting approximately one month. Over the past year, 1,100 people have been released after receiving these medications, with about 60 percent being women.
The Department of Adult Correction covers medication and visit costs for the first six months post-release through a partnership with the North Carolina Formerly Incarcerated Transition Program (NC FIT), which now covers about 70 counties. So far in 2025, the department has spent $2.7 million on medication and staffing for the program.
Expansion Challenges
Of the more than 18,000 people leaving state prisons annually, an estimated 3,000 to 4,000 could be eligible for these medications before release if the program operated at all facilities. Campbell noted that staffing shortages at prisons have hindered pre-release community provider meetings that were previously arranged. The department requested $10.5 million in recurring funding from the General Assembly but has received no dedicated funding allocation. Campbell stated the department’s intent is to expand reentry MOUD to every facility, pending funding and staffing resources. Additionally, each person exiting prison receives Narcan; since July 2024, 13,800 doses have been distributed.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.northcarolinahealthnews.org/2025/12/04/nc-prisons-reentry-medications-opioid-use-disorder/