Inside Missouri’s Crossroads Correctional Center, inmates struggling with opioid addiction have for years faced a grim choice: endure withdrawal symptoms in punitive isolation or risk their lives using illicit drugs that flow freely through the facility. A new civil rights lawsuit filed in federal court this week alleges that the Missouri Department of Corrections has systematically denied medically assisted treatment to incarcerated individuals, choosing punishment over evidence-based care in what plaintiffs call a violation of the Eighth Amendment.
The lawsuit centers on multiple named plaintiffs, including Bradley Ketcherside, who submitted repeated requests for medication-assisted treatment (MAT) for his opioid use disorder while housed at Crossroads. Each request was denied. According to court filings, Ketcherside was instead placed in restrictive housing after testing positive for opioids — a response that medical experts say worsens addiction outcomes and increases the risk of fatal overdose upon release.
A System That Punishes Illness
Missouri operates 20 correctional facilities housing approximately 23,000 people. Internal records obtained through the litigation reveal that fewer than 800 inmates across the entire system currently receive any form of MAT — a rate far below the estimated 30 to 40 percent of the state’s prison population believed to have a substance use disorder.
The disparity is staggering when compared to the federal standard. The Federal Bureau of Prisons expanded MAT access significantly in recent years, and at least 38 states now offer some form of medication-assisted treatment in their state prison systems. Missouri remains among a shrinking group of holdouts that restrict access primarily to those who entered the system already enrolled in a treatment program.
“What we’re seeing in Missouri is a two-decade-old approach to addiction that the rest of the country has moved past,” said one addiction medicine specialist familiar with the case. “Punishing someone for the symptoms of a medical condition is not corrections — it’s cruelty.”
Overdose Deaths Behind Bars
The human cost of Missouri’s approach is measurable. State data shows that at least 47 people died of suspected drug overdoses in Missouri prisons between 2022 and 2025, a figure advocates say is likely undercounted due to inconsistent reporting and toxicology delays. Crossroads Correctional Center, a medium-security facility in Cameron, has recorded at least eight overdose-related deaths during that period.
The problem extends beyond prison walls. Research consistently shows that the two weeks following release from incarceration represent the highest-risk period for fatal overdose. Individuals whose tolerance has been reduced during incarceration — particularly those denied maintenance medication — face dramatically elevated risk when they encounter street-level opioids laced with fentanyl.
Missouri’s own recidivism data tells a related story. The state’s three-year return-to-prison rate hovers around 43 percent, among the highest in the Midwest. States that have implemented comprehensive MAT programs in their correctional systems have seen measurable reductions in both overdose deaths and recidivism.
The Legal Landscape
The Missouri lawsuit follows a series of successful legal challenges in other states. Federal courts in Massachusetts, Maine, and Washington have ruled that denying MAT to incarcerated individuals with documented opioid use disorder constitutes deliberate indifference to a serious medical need — the legal standard for Eighth Amendment violations in custodial settings.
In 2023, a landmark settlement in Washington state required the Department of Corrections to offer all three FDA-approved forms of MAT — methadone, buprenorphine, and naltrexone — to any inmate with a clinically diagnosed opioid use disorder. The settlement also mandated continuity of care upon release, connecting individuals with community treatment providers before they leave custody.
Legal observers expect the Missouri case to hinge on whether the court finds that the DOC’s blanket restrictions on MAT access constitute a policy of deliberate indifference, rather than isolated instances of inadequate care. The distinction matters: a finding of systemic indifference could require the state to overhaul its treatment protocols across all 20 facilities.
What Treatment Looks Like
The evidence supporting MAT in correctional settings is extensive. A 2024 study published in the Journal of the American Medical Association found that incarcerated individuals who received buprenorphine during their sentence were 75 percent less likely to die of an overdose in the year following release compared to those who received no medication. The same study found a 32 percent reduction in reincarceration rates among the treatment group.
For county jails, which often hold people for shorter periods, the calculus is even clearer. Short-term MAT initiation during pretrial detention has been shown to increase engagement with community treatment programs after release, breaking the cycle that drives people back into the justice system.
The cost argument, often cited by state corrections departments resistant to expanding MAT, has also been undermined by recent data. A 2025 analysis estimated that comprehensive MAT programs in state prisons cost between $3,000 and $5,500 per patient annually — a fraction of the $35,000 to $45,000 annual cost of incarcerating a person who returns to prison on a new drug-related charge. Understanding the difference between jail and prison settings is critical, as treatment approaches must be tailored to the length of stay and security level of each facility.
What Happens Next
The Missouri DOC declined to comment on pending litigation but has previously stated that it provides “appropriate medical care” to all individuals in its custody. The department’s current policy permits MAT only for pregnant women and individuals who entered custody already receiving treatment — a restriction the lawsuit argues is medically indefensible.
A hearing on a preliminary injunction is expected within the next 60 days. If granted, it could require Missouri to begin offering MAT to inmates with documented opioid use disorder while the broader case proceeds. For people like Ketcherside, who has now been denied treatment for over two years, that hearing cannot come soon enough.
The case is being watched closely by corrections officials and advocacy groups in neighboring states, several of which maintain similar restrictions on MAT access. A ruling against Missouri could accelerate legal challenges across the region and add momentum to a national movement that has already transformed addiction treatment in dozens of state prison systems.
