Rolling back solitary confinement reforms won’t make prisons safer

Thousands of New York prison guards went on strike to demand changes to the HALT Solitary Confinement Act. They claim limitations on solitary confinement have worsened working conditions. Here’s why the decision to return long-term isolation to New York’s prisons won’t fix things.

by Emmett Sanders, April 11, 2025

While the international community has long recognized solitary confinement as a form of torture, in the United States, the practice is as ubiquitous as the prison system itself. A 2023 report from Solitary Watch noted that on any given day more than 80,000 people in U.S. prisons are held in solitary confinement. People may spend months or even years in isolation, with devastating results. The HALT Solitary Confinement Act (HALT), passed in 2022 and advanced by the New York Campaign for Alternatives to Isolated Confinement (many of whom are themselves survivors of solitary confinement), was intended to change this for people in New York’s prisons. While this legislation did not eliminate the use of solitary confinement altogether, it made important changes like limiting stays to 15 days at a time, initiating review practices, and providing protections for vulnerable populations like the elderly, pregnant people, and those with mental or physical disabilities. However, as in many places that have attempted solitary confinement reform, these efforts have been met with resistance.

In February, correctional officers across the state of New York began a “wildcat” strike, an unsanctioned work stoppage in violation of New York law. For 22 days, around 15,000 correctional staff across 42 prisons refused to work, forcing Governor Kathy Hochul to call in the National Guard as a stopgap measure. As might be expected, incarcerated people bore the brunt of harm of the strike; at least seven incarcerated people died during the strike. There were also reports of insufficient medical care, dangerously filthy living conditions, and the interruption of programming and visitation. Striking corrections officers’ representatives claim the strike was a desperate response to deteriorating working conditions and understaffing, much of which they blame on HALT.

Ultimately, Hochul gave in to strikers’ demands to rescind HALT protections, first temporarily suspending them, then later agreeing to extend this suspension pending further evaluation,¹ a move that illegally sidesteps the legislative process.² The rollback of HALT protections leaves people in prison once more subject to extended isolation in solitary confinement. It will also do little to improve working conditions or to fix staffing concerns and stands to make prisons even less safe.

Unpacking the claim that solitary reforms have compromised safety

Strikers’ claims that the HALT Act’s restrictions have hamstrung correctional officers’ ability to maintain order is dubious at best. This is largely because many prisons have simply ignored HALT provisions, routinely violated the law, and have continued to use solitary confinement in much the same manner as before. New York’s Office of the Inspector General, as well as a June 2024 court ruling found that:

• 40% of people were held in solitary confinement longer than the law allowed;
• 24% of the time, people were held without sufficient evidence of a segregable offense;
• People were routinely held hundreds of days past the 15-day time limit without sufficient review;
• People with disabilities have also continued to be thrown in solitary; and
• The head of the prison system even issued a blanket order to use restraints for all out-of-cell activities, in direct violation of the law.

Correctional officers’ claim that a tool has been taken out of their toolbox is disingenuous when that tool is still being used every day, and in much the same way it was before the law changed. Simply put, you cannot attribute a rise in violence to a change in policy when you have refused to implement that policy.

Dubious statistics around rising staff assaults

Reports do show rising numbers of assaults on staff as well as on incarcerated people. However, this rise predates the implementation of the HALT Act by several years. Between 2012 and 2014 the number of assaults on staff nearly doubled. In fact, both the number of staff assaults and the rate of staff assaults per incarcerated person have risen every single year since 2016. Thankfully, the vast majority of incidents result in “no injury” at all to correctional staff staff and most others result in “minor injuries” that “require no or minimal treatment.”³ It is also worth noting, like the department of corrections itself does, the distinction between assaults as defined by penal law, “which require physical harm,” and assaults as defined by department policy; according to its policy, “events where no physical injury occurs and events where any object, including a small object, is thrown at and hits another person” can result in assault reports. While this current spike is concerning and should be investigated, formerly incarcerated advocates also point to a history of correctional staff falsifying reports and weaponizing the disciplinary process to cover up a culture of abuse. One formerly incarcerated survivor of abuse at the hands of correctional officers noted, “They control the statistics.“

Skepticism also surrounds the timing of the strike, which comes just as the department faces public outcry after correctional staff accidentally videotaped themselves beating an incarcerated man, 43 year-old Robert Brooks, to death in December. More than a dozen correctional staff were indicted in the case on February 20th, which drew national attention. Critics point to previous work stoppages which coincided with allegations of abuse and increased scrutiny.

Claims that changes in the use of solitary confinement are responsible for a massive staffing shortage in New York Prisons also bear closer scrutiny. Most jails and prisons across the country have not implemented reforms to solitary confinement, but have seen similar recent reductions in staffing levels. While physically and mentally hazardous working conditions are certainly a contributing factor, they are far from the only reason. In fact, in a recent survey by Corrections Today, the top three reasons people reported leaving corrections were work-life balance, pay, and a lack of flexibility in schedule. Safety concerns ranked 8th on the list of 15.

Prisons are not understaffed, people are over-incarcerated

Moreover, prisons are not understaffed, but rather people are over-incarcerated. In New York, much of the problem lies in the fact that despite massive reductions in the prison population that have far outpaced reductions in staff, correctional officers and politicians alike have actively opposed efforts to decarcerate. While New York has managed to close a number of prisons since 2011, saving taxpayers more than $492 million, these efforts have been met with resistance and, at times, resignations from correctional staff. They persist in fighting to keep prisons open, even when they are two-thirds empty, when these facilities could be closed and their resources reallocated. Their argument is that closing prisons will bring economic collapse to small towns. These claims underscore that incarceration is indeed an industry in which the primary end-product is human misery. They are also patently untrue; prisons actually weaken rural economies.

A closer look at the numbers shows how problematic this insistence on keeping unnecessary prisons open actually is. Since 2003, the number of prison staff has fallen by just over 32%. However, New York’s prison population has fallen by more than 49% over that same period of time. Indeed, while prison staff dropped around 6% between 2020 and 2021, the incarcerated population dropped nearly 11% that same year and had fallen 22% the year before.

Perhaps most interestingly, the ratio of correctional staff to incarcerated persons stood at 1:2.4, or around one staff member for every 2 to 3 people incarcerated in New York prisons. This ratio is actually better than in 2018. In fact, the most recent national data show that New York prisons have the best staff-to-incarcerated person ratio in the nation. However, this is undercut by maintaining prisons that are far below capacity, largely because of, as the Department of Corrections notes, “the security needs that exist in the facilities regardless of the incarcerated individual population.”

Solitary confinement doesn’t prevent harm, it creates it

Counter to strikers’ claims that the use of solitary confinement is necessary to maintain safety, isolating people who often already have mental health support needs in prison conditions that impair emotional, social, and cognitive function does not make anyone safer. Solitary confinement doesn’t reduce prison violence, nor does it make people rush to fill out applications for prison jobs and make prisons better staffed. What is does do is create lasting harm that shortens people’s lives, devastates their mental and physical health, has been associated with heightened risk of suicide and self-mutilation, and further entrenches racial and gender disparities in the prison system. Even worse, perhaps, solitary confinement has actually been shown to diminish public safety by increasing the chances of a return to prison after people come home. Research has repeatedly shown that reducing the use of solitary confinement significantly reduces prison violence.

Ultimately, the crisis in New York prisons is one of an ongoing commitment to brutality rather than a crisis of capacity, and it is not one that will be resolved by doubling down on state-sanctioned torture and abuse. If New York wants to resolve the capacity issues that strikers claimed were at the heart of their protest, the state needs to address the real issues, rather than attack a humane reform that has never fully been implemented. HALT’s provisions should be fully reinstated, and, as incarcerated journalist Eric Williams rightfully points out, the state should implement legislation, and common-sense policies that can safely and cost-effectively further reduce New York’s prison population. Most importantly, the state should continue to close unnecessary prisons and fund new forms of economic development in these rural communities that don’t rely upon the narrative that incarcerated people are, as one New York legislator has claimed, “the animals of society.“ They are not. They are family members and loved ones. They are human beings, and they should not be subjected to torture.

Seven facts about mass incarceration that sound like April Fools’ Day hoaxes, but aren’t

Fines for suicide attempts, prisons built near toxic wastelands, the overwhelming number of people in the system…it's hard to believe, but it's true.

by Wanda Bertram, April 1, 2025

We at the Prison Policy Initiative are in the business of making America’s draconian, exploitative, sprawling incarceration system more obvious to everyone. The basic facts of mass incarceration are easy to grasp when laid out in, say, a pie chart. But there are other elements of the criminal legal system that never stop boggling the mind — even for us.

For April Fools’ Day, here are seven facts about incarceration and supervision that are as hard to believe as they are hard on people in the system:

Prisons and jails maintain “welfare funds” that are supposed to benefit incarcerated people, but often use the money to shore up their budgets or spend it on treats for themselves.

When incarcerated people and their loved ones pay for phone calls or commissary goods, it creates revenue for companies, which kick back some of the money to the facilities themselves. This money is funneled into “inmate welfare funds.” But what happens to it then? In our report Shadow Budgets, we revealed that prisons and jails often use the funds not for special purchases on behalf of incarcerated people, but to shore up their own operating budgets — or even to pay for perks for themselves.

In one county — Dauphin County, Pennsylvania — the local paper exposed the jail using its welfare fund for purchases as inappropriate as fitness trackers and gun range memberships for staff.

For more, see the original story from PennLive.

One-third of state and federal prisons sit within three miles of federal Superfund sites.

Research warns against living, working, or going to school near Superfund sites — the most toxic places in the country — as this proximity is linked to lower life expectancy and a litany of terrible illnesses. But many incarcerated people have no choice. With many prisons located near toxic wastelands, people in prison all too often develop health problems: For instance, in western Pennsylvania, a state prison located on top of a coal waste deposit has led to skin rashes, sores, cysts, gastrointestinal problems, and cancer.

The average yearly income of someone in jail pretrial is less than $20,000.

Nearly half a million people are sitting in a local jail awaiting trial. Their average yearly income hovers just under $20,000, meaning that it’s easy to keep them locked up by imposing cash bail (the median bail amount for people detained on bail who are accused of felonies is $25,000). Women and Black people in jail have even lower incomes on average, making them even more vulnerable to being stuck in pretrial detention, which can very quickly lead to losing one’s job, losing custody of children, forgoing medical appointments, and so on. And pretrial detention doesn’t just throw someone’s life into chaos — it makes it more likely that they will plead guilty just to get out of jail.

Felony convictions may not disqualify someone from being president, but they still block people from jobs like bartending, car sales, and pest control.

19 million people in America have felony records. And occupational licensing requirements, the standards and rules that govern who can work in certain professions, often explicitly exclude anyone with any felony conviction. These rules thus lock millions of people out of jobs like nursing, sales, bartending, and firefighting, no matter the details of their conviction — making it much more likely that formerly incarcerated people will end up in low-paying, itinerant jobs rather than stable employment.

You can’t help but ask: If someone with a felony conviction isn’t barred from becoming president, why should they be barred from all of these positions that have far less power and responsibility?

Many of the 2.9 million people on probation have to take regular drug tests — which they often must pay for — even those whose convictions have nothing to do with drugs.

In our report One Size Fits None, we combed through probation rules in 76 jurisdictions and found that 62% of those places require all people on probation to submit to regular drug tests. Not only is drug testing dubiously effective in advancing any public safety goals; the rules mean that even if someone’s conviction had nothing to do with drugs, they have to get tested anyway. Worse, many of these jurisdictions make people on probation pay for their own tests, at a cost of between $15 and $20 per test (often multiple times a week).

Several state prison systems slap financial sanctions on people who attempt suicide or harm themselves.

Not only do most prisons coerce incarcerated people to pay copays to see a doctor; some actually make people pay the prison back for costs incurred through acts of self-harm. Iowa, Georgia, Nevada, and New Mexico’s policies on disciplinary fines state that incarcerated people can be made to reimburse the state if they attempt suicide or hurt themselves in prison, an environment known to aggravate mental illness. In Virginia, corrections staff recently discussed financially penalizing people who self-immolated in protest last year.

Nearly half of all Americans have an immediate family member who has been incarcerated.

FWD.us reports that 113 million adults, or 45% of all adults in America, have had an immediate family member locked up for at least one night. These figures underscore that while having a criminal record — or even having an incarcerated loved one — carries heavy stigma in this country, it is an incredibly common experience. Making the criminal legal system fair and just is not something that impacts a select few; it’s directly relevant to our friends and neighbors.

And 10 things you shouldn’t believe

While these facts about incarceration are hard to believe but unfortunately true, there are also a number of myths floating around about the criminal legal system. Head over to our recent report Mass Incarceration: The Whole Pie 2025 where we bust 10 common myths about incarceration the far too many people do believe. We cover the exaggerated impact of private prisons, phantom “factories behind fences,” the crime waves that weren’t, and more.

Resource spotlight: UCLA Law Behind Bars Data Project leads the way in prison mortality statistics

There is less transparency about prison deaths than ever before. A new central resource aims to bring carceral mortality data out of the shadows.

by Leah Wang, March 24, 2025

For almost 20 years, from about 2000 until 2019, the federal government offered at least some idea of how many people across the U.S. die in prisons and jails each year, thanks to the Death in Custody Reporting Act (DCRA). But for the past six years, policy changes have left researchers, journalists, and advocates on their own when it comes to learning of deaths in custody.¹ Prison and jail mortality data — now irregularly published by the Bureau of Justice Assistance (BJA) — are now far less detailed, and consistently underreport deaths.²

Fortunately, a passionate team of data-wranglers at UCLA Law — an extension of the invaluable UCLA Law Covid Behind Bars Data Project — has shifted their focus to report on all-cause mortality in state and federal prisons, filling the void left by the DCRA implementation turmoil.

Given the current administration’s values and priorities, it’s reasonable to expect less criminal legal system data transparency from federal agencies over the next few years, not more. At a time when the public is paying increasing attention to what happens behind bars, we highly recommend checking out academic and grassroots resources like the UCLA Law Behind Bars Data Project (we’ve curated a list of others at the end of this post).

Tracking prison deaths

Led by two of the country’s leading scholars on prison and jail conditions, UCLA Law professors Sharon Dolovich and Aaron Littman, the Behind Bars Data Project is “the country’s most comprehensive public resource tracking prison deaths nationwide.” Project team members tirelessly submit public records requests, compile and web-scrape publicly-available mortality data, and work with partner organizations to pull together data by state. The website allows users to examine deaths in each state’s prisons, with helpful context like the total prison population and a calculated crude mortality rate for recent years.

This screenshot from the UCLA Law Behind Bars Data Project website shows how users can compare prison death counts and rates across states.

Even with all the hard work of the UCLA Law Behind Bars Data Project team, not all jurisdictions are forthcoming with all aspects of mortality data, such as the name, race, or sex of those who have died, where they died (i.e., inside a cell, a medical unit, or an outside hospital), or the circumstances of their deaths. Helpfully, each state’s Data Reporting Summary indicates what details each state has made available.

The team is also analyzing the mortality data, examining possible drivers and correlates of prison deaths such as restrictive housing (also known as solitary confinement), racial disparities, length of incarceration, and other factors. They anticipate completing more research, blog posts, and peer-reviewed publications in the near future.

Prison deaths in context: Using the data to demand transparency and change

A wide swath of academics, journalists, and advocates have been utilizing UCLA’s mortality datasets for a few years at this point. (We, for example, wrote extensively about the COVID-19 pandemic ravaging prisons and jails using the team’s data). Data users are urging lawmakers and correctional officials to implement common-sense reforms, like releasing medically vulnerable and/or elderly people from prisons, overhauling bail practices to reduce jail time, and improving access to medical care and basic life-sustaining measures like air conditioning and adequate food in prisons. Meanwhile, some of the mortality data being published by states are heavily redacted and limited, so some advocates are simply asking for more transparency and stronger reporting systems.

As the Behind Bars Data Project team continues to collect and analyze prison mortality data, they also have plans to look more broadly at measures of the health of people in carceral institutions using creative sources of information on healthcare access, expanding our collective understanding of how incarcerated people contend with illness and death in “death-making institutions.” As we at the Prison Policy Initiative are among those working to shed more light on correctional health issues and the inadequate healthcare in prisons and jails, we are excited for what’s to come from the Behind Bars Data Project.

For further reading, check out some other valuable resources on justice-involved deaths:

• Reuters’ investigation of jail deaths in 2020, which led to the largest and most comprehensive database of jail deaths to date;
• The Washington Post’s database of police shootings, covering over 10,000 fatal police shootings from 2015 to 2024;
• A front-page article from The New York Times on the COVID-19 pandemic’s impact on prison deaths, which prominently featured the work of the UCLA Law Behind Bars Data Project;
• Ongoing investigations by the Atlanta Journal-Constitution on scores of deaths and tight-lipped corrections officials in the Georgia prison system;
• A multi-year data collection effort of facility-level prison deaths in Louisiana led by law professor and leading expert on prison conditions Andrea Armstrong;
• Finally, Ida B. Wells, who courageously tracked extrajudicial lynchings in the late 19th century, leading to her statistical bombshell, A Red Record.

Danger in the water: Report exposes widespread water contamination in Texas prisons

Thousands incarcerated in Texas’ prisons may have been exposed to lead, arsenic, and other dangerous contaminants.

by Emmett Sanders, March 14, 2025

An organization in Texas has sparked concerns with a new report finding that the water in many of the state’s prisons is likely dangerous to drink. Texas Prisons Community Advocates (TPCA) is a grassroots advocacy organization whose work (like their 85 to Stay Alive campaign) focuses on exposing dangerous and inhumane prison conditions. Their new report examines the results of water samples taken from the state’s prisons by the Texas Commission on Environmental Quality (TCEQ), the state’s agency for environmental oversight. TPCA examined publicly available records of samples that were taken across 16 Texas prison water systems between 2019 and 2023. Overall, dangerous metallic and bacterial contaminants including lead, arsenic, e. coli, and more were detected in more than 90 samples. Thanks to this report, a bill (SB 1929) has already been introduced in the Texas legislature that would require more frequent and thorough water testing in Texas prisons.

The study was spurred by dozens of letters TPCA have received from incarcerated people detailing unaddressed concerns and suspicious illnesses. The major findings of the report include that:

• 38% of TDCJ water systems sampled tested positive for lead.
• Arsenic, which can cause skin, bladder, and lung cancer, as well as Copper, Coliform, and E. Coli were also found in multiple TDCJ water systems across the state.
• Of the 16 TDCJ water systems sampled, 15 received notes of violations from the TCEQ between 2019 and 2023.
• Overall, the study estimates more than 30,000 incarcerated people may have been affected by contaminated water in the 16 TDCJ water systems sampled alone.

The findings here echo those of other studies and reinforce what advocacy groups like Fight Toxic Prisons have long been saying: Prisons are built in ways that prioritize confinement over environmental safety for the people they confine. Water contamination in prisons is particularly problematic as incarcerated people rarely have the means to follow boil orders and are often given insufficient amounts of water during crises. Bottled water can be unavailable or cost-prohibitive. This can leave many with no choice but to drink, prepare food with, and bathe in water with contaminants that can cause cancer, kidney and liver failure, and death. Last year, in recognition of the right of people in prisons to be free from environmentally hazardous conditions, members of Congress introduced the Environmental Health in Prisons Act, a bill that would offer greater protections, increase oversight, and improve conditions for federal prisoners.

No prison sentence should include being forced to drink contaminated water, and neither incarcerated people nor their families should be forced to deal with long-lasting consequences that can not only undermine their physical and mental health, but can economically devastate families and communities as well. Access to clean water is a human right that must be honored for people behind bars.

Prison Policy Initiative’s Advocacy department is proud to have supported TPCA in their efforts to expose the prevalence of contaminated water in Texas prisons by helping to locate data, navigate data sources, review drafts, and provide graphics and other support like one-page fact sheets of the report’s findings. If you are a community-based advocate or legislator and would like to speak to the Advocacy department about helping with a criminal legal system reform project, please use our contact form and select the topic “Organizations and elected officials looking for advocacy assistance.”

For further information on environmental hazards in prisons, consider the following resources:

• Heat, floods, pests, disease, and death: What climate change means for people in prison
• Prisons are a daily environmental injustice

New report, Mass Incarceration: The Whole Pie 2025, shows prisons and jails continuing to lock up more people after a decade of consistent declines

The newest iteration of the Prison Policy Initiative’s flagship report explains that the incarcerated population grew by about 2% overall, with significant spikes in the incarceration of immigrants and young people.

March 11, 2025

Easthampton, Mass. — Today, the Prison Policy Initiative released the 2025 edition of its flagship report, Mass Incarceration: The Whole Pie. The report offers the most comprehensive view of the nearly 2 million people incarcerated in the U.S., showing what types of facilities they are in and why. It also serves as a primer on the size and scope of the criminal legal system and busts 10 of the most persistent myths about mass incarceration and crime.

For the first time ever, the report highlights important changes and trends in the criminal legal system, including:

• The overall incarcerated population has grown by roughly 2% since our last Whole Pie report, according to the most recent data, although the total confined population is still about 13% smaller than its pre-pandemic size;
• Recent growth in incarceration is largely driven by a handful of states, with nine states accounting for 77% of all state prison growth over 2022 and 2023. Conversely, 10 states have continued to reduce their prison population since 2021.
• Courts sent 11% more young people to incarceration in 2022 than in 2021, the first increase in youth confinement in over two decades.

“This data tells the story of states taking two divergent paths,” said Wendy Sawyer, Research Director of the Prison Policy Initiative. “The first path works to reduce the number of people behind bars, recognizing that every person who is locked up represents the failure of overly-punitive policies. The other path doubles down on the misguided policies that created the nation’s mass incarceration crisis by locking more people up, destroying lives, and making communities less safe.”

The report includes 32 visualizations that shine a light on the hidden realities of the criminal legal system in America, including:

• A pie “slice” showing the 655,000 people in local jails on any given day, including over 450,000 people awaiting trial, and over 100,000 people held by jails for other agencies.
• A graphic explaining that, contrary to a popular misconception, only 8% of incarcerated people are held in privately-run facilities.
• Graphics offering details about lesser-known parts of the criminal legal system, including involuntary commitment, civil commitment, and jails on tribal lands.

On Friday, March 14, at 1 p.m. Eastern time, Prison Policy Initiative will host an Instagram Live discussion about the key takeaways from the report and answer questions from viewers. Those interested in joining this event can use their mobile phone to set a reminder and watch here.

The full report is available at: https://www.prisonpolicy.org/reports/pie2025.html

New report reveals successes and limitations of medications for opioid use disorder in New York state prisons

A new report from a New York prison oversight agency offers insights about the need for, and challenges of, implementing medication-assisted treatment in prisons.

by Emily Widra, March 5, 2025

Substance use disorders are among the most pressing and least addressed medical conditions facing incarcerated people. While half of people in state prison have substance use disorders — far outpacing the national prevalence of 8% — only around 10% of people in state prison in 2019 had received clinical treatment in the form of a residential treatment program, professional counseling, detoxification unit, or medication-assisted treatment. In recent years, advocates in states like New York have won hard-fought reforms to expand access to treatment for those behind bars. However, while we have some information about substance use disorders and treatment among incarcerated people, it’s hard to get a good picture of how these reforms are being implemented without the insights and experiences of the people actually participating in these treatment programs.

In December 2024, the civilian oversight body of the New York state prison system — the Correctional Association of New York (CANY) — published their report on medication-assisted treatment (MAT) for opioid use disorder in New York prisons.¹ The report, which found increasing numbers of people enrolling in the program each month since it was introduced, underscores the importance of expanding access to medications for opioid use disorder (MOUD). It also examines the inherent problems with providing healthcare under the supervision of correctional staff and the value of participant perspectives for evaluating program implementation.

Addicted to Punishment Learn about medication-assisted treatment in jails and prisons.

Medication-assisted treatment is an evidence-based treatment approach that provides professional counseling or therapy combined with prescribed medications to reduce dependence on opioids. It is widely considered the “gold standard” of treatment for opioid use disorder.² This treatment is overseen by medical providers and the medications prescribed are far less dangerous than using heroin or other non-prescribed opioids outside of the treatment context. The length of treatment varies by individual, but there is no requirement that people continue MOUD forever: many people may benefit from months or years of treatment, while others may participate indefinitely.

Despite its promise, MOUD was the least common form of substance use disorder treatment in prisons: in 2016, only 1% of people with substance use disorders in state and federal prisons reported receiving MOUD at any point since their admission.³ More recently, we found that less than half (21) of all state prison systems and the federal Bureau of Prisons will continue MOUD for those receiving treatment prior to their prison admission.⁴ Only 33 state prison systems will initiate MOUD, and 14 of those will only initiate treatment in the weeks prior to release.

Only 12 states and the federal Bureau of Prisons offer both continuation and initiation of medications for opioid use disorder (MOUD) in every facility. Some state prison systems offer these opportunities at only some of their facilities, while others further restrict access to MOUD while incarcerated. For a handful of states, we were not able to find any evidence that they provide MOUD of any kind in state prisons.
Sourcing: Compiled by Prison Policy Initiative from the Jail & Prison Opioid Project (last updated 2022) and A Review of Medication Assisted Treatment (MAT) in United States Jails and Prisons from the California Correctional Health Care Services (2023), updated with information collected from news coverage and individual state prison system websites. For the data underlying this map, see the Appendix Table.

In 2021, the New York state legislature passed a law requiring MOUD programming in all state prisons to include all three FDA-approved medications and an “appropriate level of counseling.” This is crucial, as research shows that medication-assisted treatment — which definitionally involves access to therapy or counseling — works best when accompanied by psychosocial support and when providers are not limited in the medications they can offer. Other key components of the legislation include:

• That the program is completely voluntary.
• Participation is not withheld from anyone who qualifies, and it cannot be denied because of a positive drug test or because of a past or present disciplinary infraction.
• People who qualify can participate in the program at any time during their incarceration.
• The program provides reentry planning and support including information on available treatment, assistance with medicaid enrollment prior to release, and a one-week supply of any necessary medications.

From 2022 to 2024, the Correctional Association conducted multiple visits to New York Department of Corrections and Community Supervision (DOCCS) facilities to evaluate the implementation of the medication-assisted treatment program in state prisons. The Correctional Association also published the Department of Corrections’ written response to their findings. While the Correctional Association’s monitoring reports should be interpreted as helpful feedback for program improvements and an opportunity to incorporate best practices into the healthcare offered in state prisons, the Department of Corrections took a defensive posture and often explicitly contradicted the experiences of directly impacted people; we have included some of these examples from the Department of Corrections response below.

Key findings from the Correctional Association of New York’s report

The Correctional Association report offers valuable qualitative and quantitative data regarding the New York prison system’s implementation of the MOUD policy and treatment program. Notably, the departmental policy is not publicly available online and is only accessible to incarcerated people in the prison law libraries or via public records request.⁵

“The Department’s policy regarding MAT is set forth in Health Services Policy Manual (HSPM) Number 1.08. Incarcerated individuals are able to access the Department’s MAT policy in the Law Libraries of all correctional facilities. Copies may be obtained through the Freedom of Information Law (FOIL) process.” — New York State Department of Corrections response

To make matters worse, the statewide departmental policy does not include information about screening for participation, enrollment criteria, programming associated with MOUD, consequences and repercussions for misusing medications (i.e., “diversion”), or information about staff accepting, storing, and administering medications. When important information like enrollment criteria and consequences for a positive drug screening are not made explicit and accessible, potential participants can easily be discouraged from seeking necessary treatment.

Below, we discuss some of the key findings of the report, which are relevant to carceral facilities across the country.

Opioid use disorder and treatment availability in prisons

Substance use disorders are common throughout the criminal legal system.⁶ However, estimates of the prevalence of opioid use disorder specifically vary: researchers generally find that between 10% and 40% of people in prison meet the criteria for an opioid use disorder.⁷ Ten percent of all people in New York prisons (approximately 3,500 people) received MOUD in 2024, and since not everyone with an opioid use disorder receives treatment, the estimated prevalence of opioid use disorder in New York state prisons is likely greater than 10%.

The Department of Corrections is quick to point out in their response to the Correctional Association report that they have offered opioid use disorder treatment for years in the form of methadone for people who were returned to state custody from parole while receiving methadone or who entered prison while pregnant and receiving methadone. New York has indeed provided MOUD longer than many state prison systems. However, not nearly enough people in New York prisons had access to necessary care, as evidenced by the rapid increase of participation following the expansion of the treatment program to include all medications and operate at all facilities.⁸ From 2022 to 2023 alone, the Correctional Association found that the participation rate in the treatment program increased by a staggering 552%.

The prison system has also shifted away from methadone to buprenorphine as the program has expanded: in January 2023, 22% of people receiving MOUD were receiving methadone, but by March 2024 when the total participation numbers increased dramatically, only 12% of participants received methadone. Methadone treatment can be challenging to access inside and outside of prisons: by law, methadone must be dispensed as an oral medication at federally-certified opioid treatment programs. Frequently, people are required to attend these programs daily, as most people require daily doses of methadone, and the Department has 31 contracts with private medical providers for provision of these services at individual facilities.⁹

Feedback from incarcerated people receiving MOUD

In a recent Department of Corrections survey of incarcerated people receiving MOUD, 92% of people agreed or strongly agreed that the treatment has been beneficial. During the Correctional Association’s visits to facilities across the state, they encountered similarly strong support for the program:

“MAT has been a godsend. I was on [Office of Mental Health] but not anymore. MAT changed everything. It is an excellent program, and important for person’s transition home.”

“MAT program saved my life.”

“I started MAT, it has helped with mental health too — very beneficial.”

“Started MAT in February. First person at Hale Creek to get it. It is going great. I receive my medication as scheduled.”

Unfortunately, incarcerated people also report serious concerns about stigma and retaliation for participation in the treatment program.¹⁰ Many said they faced discrimination and instances where “staff call people crack heads and dope fiends” and “officers all believe we shouldn’t have the program, and they call us all drug addicts.” The Correctional Association also received multiple reports of staff assaulting people who they suspect are intoxicated or using drugs, regardless of treatment participation.

“It should be noted that the allegations of verbal, physical, and sexual abuse reported by some incarcerated individuals are not consistent with the experiences and sentiment of staff. There are thousands of daily interactions where staff maintain fairness, professionalism, and integrity when providing essential services, including the MAT program.” — New York State Department of Corrections response¹¹

Despite this defense, the Correctional Association observed skepticism regarding the utility of the program while meeting with health services teams, union representatives, and executive teams at numerous facilities. This included concerns about the “burden” on staff and resources required to implement the program. The Correctional Association reports staff endorsing “abstinence-only” approaches, and opposition to MOUD because staff perceive it as simply replacing one drug with another. This fundamental misrepresentation of medication-assisted treatment is pervasive — and deadly – outside of prisons as well: medication-assisted treatment requires more interventions than simply prescribing a new medication. The FDA-approved medications, which are far less dangerous than heroin, fentanyl, or other non-prescribed opioids, assist other forms of treatment, including behavioral therapy, case management, patient advocacy, and other supportive services.¹²

A crucial component of the law mandating medication-assisted treatment in New York prisons is that individuals cannot be barred from or removed from participation because of a positive drug screening or a disciplinary infraction, nor can they receive a disciplinary infraction for that positive screening. Despite these protections mandated by law, incarcerated people reported delays, denials,¹³ and interruptions to treatment after positive drug screenings, or for people with a history of misusing, selling, or distributing a prescribed medication (also known as medication diversion).

While the law specifically prohibits terminating or denying access to MOUD based on a positive drug screen,¹⁴ it is not clear that this information is provided to incarcerated people in any meaningful way. Instead, it is likely that people see the threat of a positive drug screen — which typically results in harsh, punitive sanctions with long-lasting consequences¹⁵ — as a significant barrier to pursuing treatment, as the medications used in treatment can and do show up on drug screenings. This would be unclear even for the few incarcerated people who access the Department’s policy via the law library or public record request, because the policy does not mention that the law prohibits the exclusion of anyone from treatment because of a positive drug screen. It is also just as unlikely that most people in prison have easy or direct access to the text of the law that mandates MOUD treatment in prison.

Operational challenges to providing effective and comprehensive substance use treatment

The Correctional Association reported that in January 2024, 25% of health services positions were unfilled across all prisons in New York, and incarcerated people said that access to timely healthcare is limited, regardless of opioid use disorder or treatment participation. At some facilities, half of people interviewed described waiting more than a month to see a medical provider after requesting medical care. MOUD recipients have an appointment with a provider every 90 days to review their treatment and, between these appointments, participants can access health services through the regular sick call process. Clearly, providing specialized substance use disorder treatment to thousands of incarcerated people inevitably places additional responsibilities on the already-strained prison healthcare system, requiring more clinicians and health support staff to adequately provide sustainable care. To meet this need, the Opioid Settlement Advisory Board allocated $11 million per year to the Department in fiscal years 2022 and 2023, and planned another $10 million in 2024. Still, the Department has struggled to properly staff facilities.

“Regarding staff vacancies, it is unclear what, if any, impact staff vacancies may have on MAT program participants. A review of the Department’s statistics provides no evidence that vacancy rates within Health Services have affected the MAT program participation and ongoing treatment. As of October 2024, statewide, the physician vacancy rate in DOCCS was 9% and the nursing vacancy rate was 41%, with vacancies supplemented with agency nursing staff.” — New York State Department of Corrections response

Providing MOUD in the prison context can be resource-intensive in other ways as well: for example, the Correctional Association reports that in several facilities, medical staff must travel to specific pharmacies to collect methadone.¹⁶ Not all facilities even have a pharmacy to store and access medication appropriately, which is particularly alarming given all the health needs of incarcerated people. In some facilities, staffing and space constraints also result in staff administering MOUD alongside regular sick calls or in the mess halls during meal time (a serious health privacy concern).¹⁷

Chronic Punishment The unmet health needs of people in state prisons.

Some incarcerated people report being encouraged to take the monthly injectable medication instead of the medications that are required daily. While this may be less resource-intensive, the medication an individual takes is a decision to be made between an individual and their medical provider based on their specific circumstances — not an opportunity to cut corners.

“Regarding the allegation that staff are encouraging or requiring participants to take monthly injectable formulations; inconsistencies with repercussions for diversion; wait times for medical care, and medication side effects, it is not possible to respond to general concerns as treatment is unique to each individual. Without identifying the individuals with a specific concern, or providing specific examples to investigate, we are not able to comment.” — New York State Department of Corrections response¹⁸

Concerns about coordinating treatment, mental health services, and other programming

New York state law requires that each person receiving MOUD works with an “authorized specialist to determine an individualized treatment plan, including an appropriate level of counseling.” Alarmingly, the Correctional Association found no mention of counseling services in the Department’s policy and found no targeted mental health, peer support, or counseling services specifically available for MOUD recipients at any of the facilities visited — in other words, they are ignoring an essential component of this treatment. The health services team that administers the treatment program is responsible for referring patients to the Office of Mental Health (OMH) if mental health treatment is required in conjunction with medications. However, there are no medication-assisted treatment-specific referral procedures, and some prisons do not have full-time mental health staff on site.

Many people receiving MOUD are also mandated to participate in the Department of Corrections’ Alcohol Substance Abuse Treatment (ASAT) program, which requires periodic drug testing (MOUD recipients are also subject to random drug screening). However, a positive drug screening results in discharge from the ASAT program.¹⁹ Health services staff reported concerns to the Correctional Association that people who might benefit most from MOUD are not open about their substance use because they fear discipline or expulsion from ASAT or the work release program (these programs are typically required prior to release).

No policies addressing medication diversion

Jails and prisons regularly cite medication diversion — when a medication is taken for use by someone other than whom it is prescribed or for an indication other than what is prescribed — as a reason to refuse to provide MOUD. In fact, research suggests that MOUD-related diversion occurs infrequently and that expanded access to treatment actually diminishes contraband medication use. Medication diversion is preventable, and researchers have identified a number of easy — and successful — interventions to limit diversion in carceral settings. However, the law requiring MOUD access in New York state prisons does not mention diversion at all, ultimately leaving questions about identifying and responding to diversion in the hands of the Department of Corrections, individual facilities, and correctional staff. The Department of Corrections policy states that “every effort” should be made to provide MOUD, but leaves room for providers to ultimately decide to “taper the patient off the medication” if an individual is “persistent in being uncooperative with the treatment plan or is demonstrating risky behavior.” Potential MOUD recipients may be understandably concerned about beginning treatment without any clear information about how diversion is identified, substantiated, and what the consequences can be for the individual.

Conclusion

The Correctional Association report highlights the positive impact that expanded access to MOUD behind bars can have on people’s lives, and offers opportunities for the New York Department of Corrections and Community Supervision to improve their treatment program to better meet the needs of incarcerated people. Research suggests that MOUD during incarceration can have profound positive impacts on the health and mortality of participants after their release from prison: it’s associated with increased community-based treatment participation and reduced opioid use and overdoses after release. Almost 4,000 people in New York state prisons receive MOUD, underscoring the need for comprehensive, supportive, and evidence-based substance use disorder treatment behind bars. These lessons are valuable beyond state borders: other jurisdictions can learn from New York’s experience implementing such a program and incorporate the Correctional Association’s recommendations from the start. Ensuring policies are publicly available to incarcerated people and the community, expanding substance use education for staff, reducing conflicts between MOUD programming and other programs, and guaranteeing access to appropriate counseling and peer support for medication-assisted treatment participants are all lessons that can help other states get off to a strong start and ensure incarcerated people have genuine access to the medical care they need.

Update on March 7, 2025: Following the publication of this briefing, we heard from Maryland officials that a statewide initiative began in September 2023 to extend MOUD access beyond the pretrial (jail) system. People receiving MOUD while in jail can continue receiving MOUD without interruption when transferred to the state prison system.

A New Billion Dollar Jail Will Leave Hawai’i Worse Off

At the request of the Hawai’i-based Reimagining Safety Coalition, the Prison Policy Initiative examined the state’s plans for a new jail and found serious issues.

by Regan Huston, February 27, 2025

On Thursday, the Hawai’i-based Reimagining Public Safety Coalition released a new analysis by the Prison Policy Initiative that closely examined plans to build a new correctional facility to replace the current O’ahu Community Correctional Center (OCCC). The memo found serious flaws with the proposed construction that would undermine public safety, exacerbate racial disparities, and worsen existing staffing problems.

The 17-page memo argues three key points:

1. Pretrial incarceration is overused in Hawai’i, causing harm to the public. A growing body of research shows that using jails to incarcerate people pretrial not only undermines the presumption of innocence, but also causes lasting harm to public safety and public health.
2. Jail expansion would exacerbate existing racial disparities in Hawaii’s criminal legal system. Hawaii’s criminal legal system disproportionately affects Native Hawaiians and other non-white minority groups. Building a new, nearly billion-dollar jail not only risks entrenching existing harmful criminal legal system practices, but also uses money that is desperately needed to improve the lives of Native Hawaiians and others in the community.
3. Building a new jail is unlikely to decrease the harms caused by pretrial incarceration, and is likely to make existing staffing problems worse.When new facilities are built without a change in the personnel delivering services inside, existing harms persist. Moreover, many of the harms caused by jailing are a result of the very fact of being removed from family and community, regardless of the conditions inside.

The memo also points out that the current plan for the jail ignores straightforward measures that could be used to reduce Hawaii’s jail population, many of which are actually cited in the Forecast Report, including:

• Changing how it deals with technical violations of probation. In January 2025, 21% of OCCC’s population were there for technical violations, such as missing appointments or not notifying a probation officer of a change of address — things that are not crimes in any other context. This is a huge percentage in comparison to other municipalities.
• Decreasing the pretrial population of its jails by implementing bail reform. As of July 2024, 61.7% of the people detained at OCCC were pretrial detainees who have not been convicted of a crime. Many of these people are there simply because they’re too poor to pay their bail.

The memo explains that with ample opportunities to lower its jail population, Hawai’i is in a strong position to decrease the number of jail beds it needs. Decarceration is the solution that is most likely to promote public health and well-being, manage staffing problems, and provide a better justice system for Hawai’i residents.

Is your community seeking to build a new jail or expand the capacity of its existing facility? We’re happy to help you push back on their arguments (drop us a line to tell us about your fight). There is no need to wait, though. We have created a how-to-guide with tips for pushing back on “jail needs assessments” that local leaders put together to justify the construction and provide strategies for pushing back on false or misleading arguments they’re making.

Federal prison rules push for “financial responsibility” while impoverishing people

Proposed changes to the Inmate Financial Responsibility Program by the Bureau of Prisons risk pushing incarcerated people and their families further into poverty

by Danielle Squillante, February 20, 2025

This week, along with the National Consumer Law Center and expert Stephen Raher, we submitted comments on the federal Bureau of Prisons’ updated proposed rules for its Inmate Financial Responsibility Program (IFRP). These rules, which we first wrote about when they were proposed in 2023, are purported to be aimed at ultra-wealthy people in federal prisons who amassed unusually large amounts of money in their commissary accounts while failing to pay legal fees and restitution. However, they’re written so broadly that they’d make the lives of the vast majority of incarcerated people and their loved ones, who are generally poorer and from disadvantaged backgrounds, much more difficult and threaten their success after their release from prison.

The Bureau of Prisons (BOP) has adjusted the rules since they were first introduced to make them slightly less punishing, but they still would have a devastating effect on incarcerated people and their families. Under these rules, the BOP would:

• Garnish 10% of wages earned by incarcerated people, which can be as low as $0.12 per hour.
• Take half of the money in an incarcerated person’s commissary account that is in excess of $250 as a one-time seizure of funds at their initial classification meeting.
• Through a series of complex and legally dubious formulas, seize a portion of the money that incarcerated people receive from their families and friends, making it even more difficult for incarcerated people to meet their basic needs behind bars.

Although the Bureau addressed some of the more egregious elements of the rules as initially drafted, the proposed changes to the IFRP are a misguided response to the false concerns that incarcerated people are hoarding money in their commissary accounts while refusing to pay legal debts. The Bureau reviewed data on commissary accounts and found that as of December 2024, only 2% of commissary accounts had balances greater than $5,000 while approximately 77% of commissary account balances were $249.99 or less. The overwhelming majority of people incarcerated in federal prisons are struggling to afford basic necessities — not living a life of luxury behind bars.

Proposed changes to the IFRP further burden incarcerated people and their families

People incarcerated in state and federal prisons were, before they went to prison, some of the poorest people in the country — and incarceration only pushes them further into poverty. In federal prisons, incarcerated people who are working earn between $0.12-$1.15 per hour. These meager wages don’t begin to cover the range of costs associated with being incarcerated, which include commissary, communication costs, and medical co-pays, to name a few. Most people, whether they have a work assignment or not, rely on outside support to meet their basic needs.

The rules ignore how frequently incarcerated people rely on items purchased from commissary to meet a range of needs throughout the entirety of their sentence. Almost everything in prison has a price tag, even for people who are considered indigent, and products are often marked up to prices far above what someone outside of the prison walls pays. Additionally, because prison meals are typically poorly portioned and of low quality, incarcerated people often rely on commissary to supplement their diet. They also rely on it for basic writing materials, basic hygiene items, clothing and shoes, religious items, and electronic devices such as fans. These additional expenses were not factored into the Bureau’s thinking on these rules but constitute a considerable cost to incarcerated people.

The proposed changes to the IFRP are particularly concerning now that the Bureau of Prisons has ended its pandemic-related phone policy of providing 500 minutes of free phone calls to incarcerated people. As of January, phone calls cost $0.06 per minute, while video calls usually cost $0.16 per minute. Although some people are eligible for free phone calls up to 300 minutes if participating in First Step Act-related programming, other families of incarcerated people will have to manage this added expense to remain connected to their loved ones.

According to the Bureau of Justice Statistics, 57% of people incarcerated in federal prisons have one or more dependent children. The incarceration of a parent or caregiver results in the potential loss of family income while creating additional costs for the family to manage — often making it difficult for families to meet their basic needs. Numerous family members of incarcerated people submitted public comments stating how difficult it would be for them to shoulder additional costs as they are already struggling financially. The proposed rules will further burden incarcerated people and their families — but they don’t have to.

An alternative approach that meets the Bureau’s goals

Rather than adopting these new rules, in our letter, we recommend an alternative approach that accomplishes the goals of the program without further burdening incarcerated people and their families. Key provisions of our recommendations include:

• Protect incarcerated people who have commissary account balances that are less than the federal poverty level from having their money seized.
• Shield incarcerated workers from having their wages garnished unless and until they earn at least the federal minimum wage.
• Exempt incarcerated people from IFRP participation for at least two years prior to reentry, given the numerous costs associated with transitioning back into the community.

The overwhelming majority of people in federal prisons and their support systems on the outside are struggling to meet their basic needs. The updated proposed changes to the IFRP are less severe than the slash-and-burn approach to debt collection they initially took, but they would still push incarcerated people and their families deeper into poverty. We urge the Bureau of Prisons to consider our alternatives to their proposal.

New Prison Policy Initiative report explains notoriously bad correctional healthcare

February 19, 2025

Why are terrible prison and jail healthcare systems so resilient against lawsuits and government oversight? How do healthcare providers cut corners with patient care to keep costs down? When and why did corrections agencies start to swing towards contracting out healthcare to companies?

In a new report, Cut-Rate Care, the Prison Policy Initiative answers these questions and others, providing a sweeping explainer of correctional healthcare. We focus on the incentives behind notoriously bad care found in prisons, and explain the major changes — in particular, a shift away from control of healthcare by departments of corrections — that would be necessary to reorient these systems toward a public health approach to care.

People in prison have unique health needs, suffering disproportionately from illnesses like Hepatitis C, HIV, and substance use disorder. As we’ve shown before, these needs routinely go unmet in prisons. Our new report explains why: Correctional healthcare systems are services for corrections departments, not incarcerated people, and are therefore focused less on patient care and more on avoiding lawsuits.

The explainer covers:

• The ways prisons protect themselves against legal consequences for poor medical care, from contracts that offload responsibility onto private companies to federal and state laws that stymie legal action.
• The history of privatization in prison healthcare, including a table showing the three main business models of healthcare contracts in effect in prisons today.
• The few quality control measures for prison healthcare — government oversight, accreditation, and litigation — and why these have all ultimately failed to meaningfully improve the quality of care.

“With prison healthcare, you regularly see that incarcerated people’s complaints get ignored, their requests for exams get denied, and their care gets slow-walked,” said author Brian Nam-Sonenstein. “That’s because prison healthcare systems are really more like liability management systems, and what’s bad for patient care can actually be good for limiting liability.”

Beyond offering an overview of correctional healthcare, the explainer also includes:

• Policy recommendations for decision-makers at all levels of government, but particularly for state and federal lawmakers — whom we urge to remove the provision of prison healthcare from departments of corrections and transfer it to public health agencies, breaking down the “wall” that currently exists between correctional healthcare and public health.
• An appendix with a thumbnail history of the evolution of correctional healthcare, centered around the pivot to privatization since the turn of the millennium.
• Anecdotes from six incarcerated people (in six different prison systems) whom we asked about their experiences with correctional healthcare.

“Private or public, the goal of prison healthcare providers is to provide the minimum amount of care possible in order to avoid claims of negligence,” said Nam-Sonenstein. “These are medical systems caught up not just culturally, but systemically, with the handing out of punishment. That won’t change until we take correctional healthcare out of the hands of departments of corrections and give it to professionals who are solely focused on public health.”

The full report is available at: https://www.prisonpolicy.org/reports/healthcare.html.

New guide and webinar: Challenging myths about recidivism

by Wanda Bertram, February 13, 2025

Decision-makers often cite worries about recidivism as a primary reason to oppose criminal legal system reforms. These worries are caused by both the concept of the “revolving door” of incarceration and by politicians’ fears that a single violent recidivism event will hurt them politically. The realities of recidivism, though, are complex, and the more advocates know about the facts of how many people return to prison and what those numbers mean, the better equipped they can be to help politicians make informed decisions about policy.

Earlier this month, we released a new guide to recidivism statistics and their history, and how advocates for decarceration can challenge the way these flawed statistics are used to undermine their efforts. The new guide covers:

• The history of the “Willie Horton Effect,” why the power of political backlash against reform is overhyped, and how advocates should respond when lawmakers are swayed by isolated stories of recidivism.
• The different types of recidivism metrics and what they mean, how and why to be cautious about commonly-cited statistics, and the role of “technical” probation and parole violations and minor offenses in driving recidivism.
• Recidivism statistics related to people convicted of violent/sexual offenses, in the context of common arguments for “carving out” these individuals from criminal legal reforms.
• How advocates can push lawmakers to consider other metrics of post-release success besides recidivism, focusing on a person’s quality of life and contributions to their community.

This guide is part of our ever-expanding Advocacy Toolkit, a series of resources for criminal legal reform advocates based on our own research and advocacy.

On March 19, 2025, we hosted a webinar where our policy and advocacy team, Sarah Staudt and Emmett Sanders, discussed pushing back against unproductive and inaccurate uses of recidivism stories and statistics.