Ramon Barreira is in a familiar place: on parole. Again. At age 46, he’s been in and out of Rhode Island’s prison system so many times, he’s lost count.

“It’s depressing sometimes to look back on it,” he said. 

It’s always drugs — buying, selling, using — that lands him in jail. He said he was 15 when he first tried heroin, and since then the pull of addiction has been hard to resist. It’s not just ending up in jail again that he fears — he is worried about dying from an overdose.

“You might not make it back,” said Barreira. “My friend OD’ed last week.”

Across the country, an estimated one-third of all inmates are addicted to opioids. Most of them are forced to detox while in prison, but the problem is, the addiction doesn't just go away. People just out of prison are at an especially high risk of overdosing, says Jennifer Clarke, the medical director for Rhode Island’s Department of Corrections.

“They’re still craving drugs,” said Clarke. "They might take the same dose they did before, but because their tolerance is down, that same dose will actually kill them.”

Two years ago, Clarke implemented a new approach to treating inmates with an addiction. Instead of taking away addiction medications, the prison provides them. And the results,published in the Journal of The American Medical Association, show the number of newly released Rhode Island prisoners dying from opioid overdose deaths in the six months after their release dropped dramatically. 

They might take the same dose they did before, but because their tolerance is down, that same dose will actually kill them.

“This is something we just don’t see very often in medicine,” said Clark, “a 60 percent reduction in mortality.”

The findings from Rhode Island will likely bolster a proposed law requiring Massachusetts prisons and county jails to also offer addiction medications, like methadone and Suboxone. These two medications reduce craving and withdrawal symptoms without producing the same high as other opioids. But because they're still opioids, the drugs create a security challenge in prisons.

“The number one most smuggled piece of contraband in all correctional facilities is Suboxone,” said Middlesex County Sheriff Peter Koutoujian.

He says one estimate put the cost of administering Suboxone in his jail at a half-million dollars. It’s not just paying for the drug, he says, but also the cost of providing extra security to make sure prisoners don’t divert and misuse the medication.

“I think people like the idea of medication-assisted treatment inside facilities. It is certainly something we should be considering,” said Koutoujian, “but I think we’re early in this game.”

Koutoujian hopes Suboxone will soon be available as an injection, a more secure mode of delivery. He also points out that addiction medications aren’t a magic bullet. He says a program in Middlesex Countythat connects people leaving prison to both treatment and medication has cut return trips to jail.

Rhode Island is looking to see whether one of its opioid treatment programs also helps people stay out of jail. Like the one in Middlesex County, it connects people leaving prison directly to addiction treatment.

Ramon Barreira, who has been out of jail for six months, says it’s the first time he’s been in recovery.

“They offer me things to stay clean,” he said, “and stay focused on what I got to do.”

He says he used to think recovery was getting thrown in prison for a couple of months. Now he realizes staying in recovery may also mean staying out of prison.

“This time is very different," he said.