Caption: Franklin County Adult Detention Center will now provide access to medication for opioid use disorder in response to KW client Beth Delacruz’s legal pressure
Like thousands of Missourians, Beth Delacruz first began struggling with opioid addiction as a teenager. Opioid addiction is the leading cause of death for people under age 45 in Missouri and the United States, and Beth is intimately familiar with that tragedy. After watching countless friends and loved ones from opioid overdoses, she decided she needed to get clean to survive. Opioid Use Disorder (“OUD”) is a chronic brain disease, and synthetic opioids like fentanyl re-wire your brain. Accordingly, the medical standard of care for treating OUD is Medication for Opioid Use Disorder (“MOUD”): methadone, buprenorphine, and/or naltrexone. For Beth, methadone quite literally saved her life.
However, in 2025 when she was incarcerated in Franklin County Jail, her Methadone was discontinued pursuant to the jail’s ban on MOUD, causing her life-threatening withdrawal. This ban on MOUD is illegal and violates both federal and Missouri state law. We challenged Franklin County Jail’s illegal ban on MOUD via a demand letter and won. Pursuant to their new MOUD policy, Franklin County Jail and its medical provider, TurnKey Health, will now allow incarcerated people who enter the jail on MOUD to continue their prescriptions while they are incarcerated. Additionally, people with OUD in Franklin County Jail will be able to initiate an MOUD prescription in jail to control their addictions. These new policies will dramatically prevent recidivism for people with OUD, prevent fentanyl relapse after incarceration, and most importantly, save lives. Franklin County’s new MOUD policy can be reviewed here.
What is MOUD and why is it necessary in jail?
Methadone is a full-agonist MOUD, meaning it stimulates the brain’s opioid receptors in a controlled fashion to control opioid cravings and allow individuals with OUD, like Beth, to live functional lives. Buprenorphine, commonly known as Suboxone or Subutex, is a partial agonist MOUD, meaning it both stimulates opioid receptors to control cravings and prevents overdose by blocking opioid receptors from excessive stimulation. Naltrexone (or “Vivitrol”) is a full antagonist, meaning it blocks opioid receptors but does little to control opioid cravings. The Federal Drug Administration (“FDA”) and every major addiction science and medical association in the United States agree that MOUD is the medical standard of care for OUD, and in many cases, necessary for survival. Despite common stigma, MOUD is not “replacing one drug with another”; it is medically impossible to overdose on MOUD.
However, most jails and prisons nationwide – and in Missouri – fully ban access to MOUD for incarcerated people with OUD. This stunning indifference to the medical needs of people with OUD is disturbing considering overdose is the leading cause of death among people returning to their communities after incarceration. On the inside, an overwhelming two-thirds of incarcerated people in American jails and 65% of people incarcerated in American prisons are living with an active substance use disorder, often an opioid addiction.
Banning MOUD in jail is deadly. Discontinuing methadone or buprenorphine sends someone with OUD into precipitous withdrawal, which can be life-threatening as it causes severe cravings, nausea, dehydration, vomiting, cramping, and more. Worse, after withdrawal, overdose risk skyrockets upon being released back into one’s community and exposed to fentanyl.
Banning MOUD in jail is also illegal. Such bans are akin to telling a diabetic “we don’t provide insulin in this jail.”
As I explained in a 2025 article, Missouri law requires meaningful access to medication for opioid use disorder in Missouri prisons and jails, including suboxone or methadone. Missouri Revised Statutes Chapter 191, Section 1165(7) reads as follows: “The department of corrections or state entity shall make available the MAT [“MAT,” or Medication Assisted Treatment is another term for MOUD] services covered in this section [which include access to Buprenorphine, Methadone, and Naltrexone], consistent with a treatment plan developed by a physician, and shall not impose any arbitrary limitations on the type of medication or other treatment prescribed or the dose or duration of MAT recommended by the physician” (emphasis and bracketed text added).
Missouri jails and prisons banning MOUD, and their contracted medical providers’ insistence on enforcing these bans, patently violates this Missouri law and constitutes illegal, “arbitrary limitations on the type of medication” of MAT prescribed to people in state or municipal custody.
Banning MOUD also violates federal law.
In 2022, the Department of Justice issued a formal guidance clarifying that the Americans with Disabilities Act (“ADA”) applies to people with opioid use disorder. The ADA is a federal statute guaranteeing that people with disabilities have meaningful access to the same opportunities as everyone else to participate in state and local government programs. The ADA specifically protects people with disabilities from discrimination by prisons and jails.
Accordingly, as the DOJ guidance clarifies, prisons and jails cannot maintain blanket policies denying continuation of MOUD (as Franklin County did), nor can they force an incarcerated person to take one medication for opioid use disorder over another (e.g., only providing access to naltrexone, but not suboxone).
Litigation nationwide has successfully asserted the rights of incarcerated individuals with OUD to continue MOUD in jail. However, such litigation is nascent in Missouri.
Success in Franklin County Jail is just the beginning
At Khazaeli Wyrsch, we fight for incarcerated people’s access to medical care, including access to MOUD.
We applaud our client Beth Delacruz for her bravery in confronting Franklin County and TurnKey Health to ensure neither she nor anyone else with OUD is denied continuity of medical care in jail.
Unfortunately, opioid addiction is a lifelong battle, and relapse is common. Every day, people who are managing their OUD with buprenorphine and methadone face the risk of relapse, incarceration, and discontinuation of the medication that makes it possible to stay sober. Franklin County is now one of approximately 10 out of the over 100 jails in Missouri that permit incarcerated people with OUD to continue their MOUD. That means approximately 90% of Missouri jails are likely violating the rights of incarcerated people with OUD by discontinuing their MOUD and fueling the opioid crisis in our state and beyond. This tragedy is nonsensical, illegal, and deadly.
If you are at risk of being incarcerated or presently incarcerated and being denied continuation of your legally prescribed MOUD, we are prepared to fight for your rights. Please get in touch via this form.
Self-Advocacy Resources
Beyond legal advocacy, we believe in empowering individuals with Opioid Use Disorder to educate themselves and advocate for themselves and their loved ones. We created the following resources to help you and yours in that fight:
- Missouri Department of Corrections MAT Self-Help Guide
- If you or someone you love is incarcerated in the Missouri Department of Corrections at any state prison, this self-help guide will help you navigate the MDOC MAT Program, assert your rights, and ensure you receive access to MAT. It will also guide you through the grievance process if you are being denied MAT.
- MOUD Know Your Rights Flyer
- If you or someone you know is living with OUD, prescribed MOUD, and at risk of incarceration, this poster will help you understand your legal rights to continue MOUD in prison or jail. Please feel free to print these posters and share them at local treatment centers.
Khazaeli Wyrsch, LLC
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