LA County can’t keep up with drug treatment demand inside jails

Los Angeles County is struggling to keep up with a rising demand for opioid addiction medications within its jails, forcing it to place more than 800 inmates on waitlists for treatment in October and November.

As of Dec. 18, the number of inmates waiting for medication-assisted treatment (MAT) has come back down to 357, according to the county, but substance abuse treatment experts say the two-month surge and the hundreds still on the list today are evidence of the desperate need for more investment in the potentially life-saving program.

“The reality of it is that if it was some other type of medical disease, we wouldn’t be talking about this in terms of how much it costs,” said Robb Layne, executive director of the California Association of Alcohol and Drug Program Executives (CAADPE). “These individuals who are looking to receive treatment for their medical diagnoses should not be any different than somebody who has diabetes or someone who has cancer.”

Layne blamed the lack of funding on the stigma associated with substance abuse disorders. It is hard to imagine the county would put someone needing insulin or heart medication on a waitlist, he said.

Expanded services urged

CAADPE, the California Society of Addiction Medicine, Drug Policy Alliance, California Behavioral Health Association and the California Opioid Maintenance Providers penned a joint letter last week calling on the county Board of Supervisors to eliminate the waitlist and to provide “full, clinical access to buprenorphine and other evidence-based medications throughout a person’s incarceration,” according to a copy provided to the Southern California News Group.

“Every overdose behind bars is preventable and every one is policy failure,” the joint letter states.

The coalition urged the supervisors to expand services to ensure anyone receiving treatment before they enter the jails is able to continue while in custody, and to ensure those leaving can transition to community providers upon release.

In November, CalMatters first reported that L.A. County Correctional Health Services’ chief medical officer had issued a memo stating the department would be “taking a pause” on ordering buprenorphine, a monthly injectable that reduces cravings and withdrawal symptoms.

County officials, however, deny there has been any decrease in its opioid treatment program, saying instead that demand is simply outpacing its resources, according to a statement from Correctional Health Services.

Correctional Health is “treating more people and providing more MAT doses than ever before,” officials said. This year, it has administered more than 100,000 doses of the oral medication suboxone and 14,000 doses of buprenorphine, up from 57,000 and 10,000 doses, respectively, in 2024.

“While the current funding is a substantial investment — unmatched anywhere else in the nation — the sheer demand in LA County results in the waiting lists we are currently experiencing,” the statement reads. Those waitlists prioritize first-time patients over inmates who have previously enrolled, discontinued treatment and then requested to restart.

Budget shortfalls

The coalition, in their letter, also raised concerns about the county’s handling of $8.2 million in settlement funds received from opioid manufacturers. The county acknowledged that it allocated those dollars to the MAT program, but rather than expanding the program, it then shifted an “equal amount of existing funds” to cover part of a $19 million shortfall in the agency’s overall pharmaceutical budget.

Officials attributed that shortfall to the “rising costs of pharmaceuticals, increase in the number of individuals in custody with medical needs, and the high medical complexity of the population in custody.”

The MAT program received about $34.2 million in the 2025-26 budget. CHS requested an additional $4.6 million for such medications and $1.5 million for staffing, but the funding was not approved, officials said.

“If CHS had been able to retain the opioid settlement funds as new net funding, without the need to realign a comparable amount to cover other pharmacy costs, it would have significantly improved our ability to meet the ever-growing demand for MAT medications,” Correctional Health Services said in a statement.

AG calls out treatment limits

California Attorney General Rob Bonta, in a lawsuit filed in September, accused L.A. County of failing to “provide adequate detoxification or withdrawal treatment” for inmates, among other allegations about “inhumane” conditions within the jails.

“Defendants limit access to the MAT program,” the lawsuit states. “Although MAT is known to prevent opioid related overdose and deaths and reduce recidivism, CHS has an exceedingly long wait list and has failed to offer continued maintenance of medication. Persons in custody who have overdosed report not having access to MAT or receiving their initial dose of the medication but then being placed on a wait list for access to follow-up medication, with a delay possibly causing a relapse and avoidable withdrawalsymptoms.”

So far this year, 45 people have died in L.A. County’s jails, with about 22% of the deaths attributed to drugs. That number could still rise — and may even surpass a six-year high — as the causes of deaths in several of the cases are still pending. Data collected from the Los Angeles County Sheriff’s Department and the county’s Medical Examiner shows that about four of the 10 drug-related deaths this year involved opioids, while eight involved methamphetamine, with some overlap in instances where both drugs were present.

There is no equivalent to the MAT program for methamphetamine use, officials said.

CHS stressed that none of the individuals identified as dying from overdoses in 2024 or 2025 was on the waitlist for medication-assisted treatment. The department, citing privacy concerns, declined to say whether any were participating in the program, or had refused treatment in the past.

Overdoses have been the second highest cause of deaths in the jails — after “natural” causes — in most years since 2016.

Spike in jail population

One of the reasons for the increased demand for treatment this year is likely due to a spike in the jail’s population.

Nearly 1,000 more people are in the jails as a direct result of the passage of Proposition 36 in 2024. The voter-approved measure placed stricter punishments on repeat drug offenders, but also promised to offer those with addictions an option to have cases dismissed by instead completing a court-approved treatment program. The law did not establish any funding mechanism, however.

Of the 1,629 “treatment-mandated felonies” filed in L.A. County from December 2024 through October 2025, about 20% — or 318 inmates — were either in treatment or sentenced to probation. Only one case had been dismissed as of Nov. 24.

Those diverted to the jails as a result of Prop. 36 have a much “higher need” for medication-assisted treatment, said Layne, the executive director of the CAADPE.

Supervisors weigh in

In response to the coalition’s letter, county Supervisor Janice Hahn said she plans to meet with the head of Correctional Health Services to “discuss the issue and the broader crisis of deaths in our jails.”

“Medication assisted treatment saves lives and everyone in our jails who needs it should be able to get it,” Hahn stated. “While our Department of Health Services has assured me that the number of suboxone doses administered in our jails has doubled in the past year, I am concerned about the growing backlog raised by these experts.”

Supervisor Hilda Solis stated that she is “deeply concerned about rising deaths within our correctional health system, driven in large part by overdoses.”

“The requests outlined in their letter are ones I support and believe would make a meaningful impact in reducing overdoses in our jails,” Solis said. “Every person in custody deserves timely, adequate, and humane health care, and we must continue working to achieve this goal.”