Rhode Island became a national model for prison addiction treatment in 2018, when researchers showed its first-in-the-nation program offering all three FDA-approved opioid medications to incarcerated people had cut post-incarceration overdose deaths by 61%. Now, a new Johns Hopkins University study is tracking whether a 2024 federal rule change could let prisons across the country achieve something similar, through a pathway that Rhode Island itself never needed.

The stakes are significant. Roughly 65% of people in U.S. jails and prisons have a substance use disorder, and people leaving incarceration are 40 to 130 times more likely to die of an opioid overdose than the general population in the weeks after release. Despite that risk, most correctional facilities have never offered methadone, one of the most effective treatments for opioid use disorder, because federal law since the 1970s has restricted its dispensing almost exclusively to specially licensed clinics that carry staffing and certification requirements nearly impossible for prisons to meet.

A final rule issued by the Substance Abuse and Mental Health Services Administration in 2024 changed that calculus. It clarified that any carceral facility already registered with the DEA as a "hospital/clinic" can stock and dispense methadone for opioid use disorder, as long as the patient is also being treated for another medical condition. Because most incarcerated people with opioid use disorder have co-occurring conditions including mental illness, hepatitis C, HIV, or chronic pain, that requirement is rarely a barrier in practice.

Three state prison systems, Colorado, Delaware, and Washington, are now actively rolling out methadone access under this new designation. The Johns Hopkins-led study, funded through the National Institute on Drug Abuse, is embedded in that real-time expansion. Researchers will track implementation challenges, measure how many incarcerated people start and stay on methadone before release, and link prison records to Medicaid claims in Washington State to follow what happens after people leave. A parallel cost-effectiveness analysis will give policymakers data on the budget impact, not just the health impact.

Rhode Island's role in this story runs deeper than inspiration. The state's unified correctional system, which combines prisons and jails under one roof in Cranston, made system-wide treatment rollout logistically feasible in a way that most states' fragmented systems can't replicate easily. The new federal pathway, which works through an existing DEA registration rather than requiring a full opioid treatment program license, is designed to be more scalable precisely because it sidesteps the structural barriers that kept methadone out of prisons even as the fentanyl crisis intensified.

Whether correctional systems will actually use the new pathway remains an open question. Institutional resistance, staffing shortfalls, and political opposition in some states have slowed MOUD expansion even where it's been legally permissible. Researchers say this is exactly why the implementation study matters. Similar work tracking how emergency responders and peer networks can extend the reach of addiction treatment is underway in other cities, including a Columbus project testing whether paramedics can reach overdose victims before it's too late.

The study runs through 2028. Its findings are expected to shape decisions at the state and federal level about whether the hospital/clinic designation gets widely adopted, expanded, or revised.