April 9, 2024

North Carolina is facing an overdose death crisis where our loved ones, friends, and neighbors are being tragically taken away from us. We interact daily with affected individuals in our communities, from places of worship to schools and workplaces. Despite having lifesaving tools like medications for opioid use disorder (MOUD) within our reach, we’re failing to provide access to them.

This lack of access extends to NC’s jails. In large part due to the inadequacy of community services, people with disabilities, including those with opioid use disorder (OUD), are overrepresented in NC jails and prisons. In 2023, Disability Rights North Carolina (DRNC), the state’s Protection and Advocacy organization charged with safeguarding the legal rights of nearly 3 million North Carolinians with disabilities, began an in-depth look at the availability of MOUD in NC jails.

Our report, Saving Lives: Ensuring Access to Medications for Opioid Use Disorder (MOUD) in NC Jails provides a detailed overview into the issues of opioids and MOUD, DRNC’s findings, barriers and problems within NC jails, helpful resources, and actionable recommendations for change. DRNC staff found that 37 percent of NC’s jails provide MOUD, which is slightly better than the national average of 30 percent, as detailed in a March 2024 report released by the O’Neill Institute for National and Global Health Law. Still, much room for improvement remains.

OUD is not merely a personal struggle, it’s a medical condition and a disability. There are legal bases to require that MOUD be provided to people with OUD in our jails and prisons: the U.S. Constitution and the Americans with Disabilities Act (ADA). Under the ADA, people with disabilities are safeguarded from discrimination. Denying access to medications for treating OUD is a form of discrimination.

“Providing access to MOUD in jails is a growing effort across the state and the nation, and there are many resources available to help jails start an MOUD program,” said Lisa Gessler, the DRNC attorney who led the examination along with DRNC advocate Dane Mullis. “There has been some progress since we initiated this project, but there is still much work to be done to save lives and keep people safe. Jails must focus on improving access to treatment and removing stigma. MOUD is simply a medication to treat a condition.”

DRNC, a leading advocate for people with disabilities, has federally-granted access authority to obtain information affecting disabled people who are jailed in all North Carolina’s 100 counties. As DRNC gathered information, we also provided education and information to people with disabilities who experienced discrimination and to the sheriffs, their staff, other county employees, and community providers.

There are three FDA-approved medications designed to address OUD, with methadone and buprenorphine emerging as the most effective.

Methadone and buprenorphine not only treat the disorder – they also significantly reduce the risk of fatal overdoses and the return to illicit drug use and increase the likelihood of remaining in treatment. By providing access to these medications, individuals struggling with OUD have the chance to heal and rebuild their lives. Denying them this opportunity is to rob them of a future that’s within their grasp.

Jails have a unique opportunity to provide access to critically needed MOUD and have a major impact on NC’s overdose death crisis. While some jails are providing this lifesaving treatment in their facilities, others are not. Providing these medications is a best practice for our communities and puts NC on the right track to stop the overdose death crisis.

DRNC recommends:

  • The State, public health directors, and other community leaders should expand public education to reduce stigma around OUD and its
  • Community medical professionals who specialize in OUD and the use of MOUD should provide ongoing education to law enforcement, jail staff, and detention facility third party medical providers. This education should focus on OUD as a disability, the effectiveness of MOUD, and proper access to MOUD. This education should be continuing, not a one-time
  • Remove barriers to access of MOUD in jails and prisons. MOUD should be available and easily accessible for people with OUD. Stop the use of drug screens on intake to deny MOUD and other rigid rules around access (e.g., do not force someone to engage in therapy to receive medication), do not discontinue access to medication as a punishment, and remove arbitrary limits to medication types and dosages – this needs to be assessed
  • The State must require that MOUD, including agonist medications, be made available to people with OUD in all NC jails and If the facility does not have the ability to provide MOUD, anyone who needs MOUD should immediately be transferred to another facility.
  • Community leaders and policymakers need to support the use of MOUD in carceral settings and efforts to help those released re-integrate into their community by publicly supporting and improving funding for these programs, and providing guaranteed continued access to MOUD to people who are uninsured when they leave the This must include assistance from the Local Management Entity/Managed Care Organization (LME/MCO) to make sure that all people with OUD who are leaving the facility are connected with services.


About Disability Rights North Carolina

Disability Rights North Carolina is the federally mandated protection and advocacy system in North Carolina, dedicated to advancing the rights of all people with disabilities, of all ages, statewide. DRNC is an independent, 501(c)(3) nonprofit organization and a member of the National Disability Rights Network. Learn more about Disability Rights North Carolina at


Lisa Gessler, Attorney