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— which has one of the highest incarceration rates and largest prison populations in the world — drug use disorders are 12 times higher among those at prison intake versus the general population, and opioids make up more than half of postrelease overdose deaths.36 The two weeks to one month after release from a correctional facility represent a period of significantly elevated risk of overdose, something noted in nearly every jurisdiction in this analysis as a crucial element to address.37 West Virginia — which has one of the highest incarceration rates per 100,000 people in the world — ensures each person is actively connected to community care upon release.38 Maryland’s 2024 Medicaid 1115 waiver extended coverage to incarcerated people 90 days before release, with the waiver set to pilot in two facilities in 2026 before statewide expansion.39 In Ohio, naloxone release kits are provided to everyone upon reentry, and in 2024, initiated a pilot program to provide long-acting injectable buprenorphine on release.40 Delaware is working to formalize a Recovery Friendly Workplace initiative which will extend naloxone access and recovery support into human resources policies of participating employers.41 New York provides services in all 58 jails and 41 prisons, reaching nearly 20,000 people with a noted sevenfold increase in medications for opioid use disorder between 2022 to 2025.42 Canada and Scotland both distribute naloxone in prisons and upon release.43 Canada seeks to coordinate care with Indigenous governance structures to support provincial Indigenous populations upon reentry