West Virginia has been at the epicenter of the American opioid epidemic for over a decade — the state has consistently reported among the highest per-capita opioid death rates in the country, with counties like Mingo, McDowell, and Cabell recording mortality rates that are catastrophic by any measure. The state's prison and jail system reflects this reality: a disproportionate share of West Virginia's incarcerated population has opioid use disorder, and the period immediately following release from incarceration has been documented as one of the highest-risk windows for fatal overdose.
In response, the West Virginia Division of Corrections and Rehabilitation (WVDCR) has expanded its Medication-Assisted Treatment (MAT) programming across its facilities — a shift that reflects growing evidence that abstinence-only approaches in corrections settings are medically ineffective and that withholding FDA-approved addiction treatment from incarcerated people is increasingly viewed as a civil rights violation.
What MAT Is and Why It Works
Medication-Assisted Treatment for opioid use disorder combines FDA-approved medications with counseling and behavioral support. The medications used in West Virginia's prison MAT programs include:
- Buprenorphine (Suboxone, Subutex): A partial opioid agonist that reduces cravings and blocks the euphoric effects of other opioids without producing significant sedation at therapeutic doses. It is taken daily as a sublingual film or tablet.
- Naltrexone (Vivitrol): An opioid antagonist that blocks opioid receptors entirely — it prevents any opioid from producing an effect. Available as a monthly injectable, making it particularly useful for people approaching release (the shot lasts 28-30 days, providing coverage through the highest-risk initial release period).
The Post-Release Overdose Risk
The mechanism of the post-release overdose risk is well-established: a person who was using opioids before incarceration enters a prison where opioid access is severely limited (though not eliminated — contraband persists). Without opioids for weeks or months, their physical tolerance drops dramatically. When they are released — often with little transition support, into an environment of poverty and triggers — they may use at pre-incarceration quantities that their reduced body can no longer tolerate. The dose that was normal before incarceration can now be fatal.
MAT, particularly long-acting naltrexone (Vivitrol), addresses this risk directly. A person who receives a Vivitrol injection in the week before release cannot get high from opioids for 28-30 days — the receptors are fully blocked. This buys a month of protection during the highest-risk window, during which treatment and recovery support services can be established in the community.
WV DOC's MAT Expansion
West Virginia DOC has expanded MAT from a limited pilot to availability across its facilities, driven by a combination of federal settlement pressure, Medicaid expansion (which covers MAT for eligible participants after release), and the clear public health data on post-release overdose deaths. The expansion has involved training medical staff, addressing concerns from corrections officers about buprenorphine being diverted and sold, and establishing protocols for medication delivery that maintain security while providing therapeutic access.
For Families
If your loved one is incarcerated in West Virginia and has opioid use disorder:
- Ask the facility's medical unit directly whether MAT is available and how to enroll
- Request that a Vivitrol injection be scheduled for the week before release — this requires advance planning and approval
- Connect with West Virginia's Healthy Connections (wvhealthyconnections.org) for reentry support services linked to MAT
- The West Virginia Center on Budget and Policy tracks WV correctional health policy developments
WVDCR headquarters: 1409 Greenbrier Street, Charleston, WV 25311. Phone: (304) 558-2036. Website: dcr.wv.gov.