Gripped by opioid withdrawal, Benjamin Santiago was violently ill when he stepped into San Mateo County’s Maguire Correctional Facility last fall.
At 44, he had been using illicit opioids for more than two decades, bouncing in and out of juvenile halls and then county jails across the Bay Area for selling drugs — including to his own parents — to pay for his addiction.
On that cool November day, the jail staff interrupted that downward cycle, offering Santiago a medication that would blunt his opioid cravings and drastically improve his chances of staying sober, staying alive. For the past two months, doses of buprenorphine have taken the teeth out of Santiago’s intense cravings. He’s started to envision a new course for his life when he’s eventually released.
“This is the first time I’ve ever thought about being sober when I get out,” he said.
Amid an epidemic of drug overdoses that’s finally showing signs of slowing in California, public health experts are improving access to drug treatment in prisons and jails, which are often awash in fentanyl and other smuggled drugs. Nationally, drug and alcohol overdose is a top cause of death in jails and the leading cause of death for those who have been recently released.
Thousands of other people imprisoned in county jails may soon have access to such ‘medication assisted treatment’ in the next two years. At the direction of Gov. Gavin Newsom, the state’s Medicaid program is beginning to pick up part of the tab for the costly treatment. For instance, a single shot of buprenorphine costs more than $1,200 and cuts cravings for a month. State rules will require all jails to provide inmates with a suite of addiction treatment options by October 2026.
The change is part of CalAim, a broad expansion of the the state’s health care provider for low-income residents, Medi-Cal, to cover non-traditional services such as housing and care for those who are incarcerated.
After California prisons began providing opioid addiction medications in 2020, overdose deaths of imprisoned people declined by 58%, according to the California Department of Corrections and Rehabilitation.
“These medications are life and death for someone coming out of custody and in that state,” said Mary Taylor, who leads San Mateo County’s push to make addiction treatment drugs more available on the San Francisco Peninsula, including in county jails.
A slew of challenges hamstring the ability to deliver addiction medication in jails, Taylor and health officials said. The need is vast, but logistical problems hound efforts to keep people who are imprisoned on a regular schedule of medication. It’s unclear if correctional health staff will be able to make good on California’s effort to make the vital medications more available.
Under the state’s expansion of care, staff at correctional facilities like the one in Redwood City are required to assess inmates for opioid addiction and, if they qualify, provide options for treatment. That includes Sublocade, the injection of buprenorphine, an opioid addiction treatment approved by the U.S. Food and Drug Administration, that Santiago receives monthly to quell his cravings.
Santa Clara County began complying with the new state rules in October, and San Mateo County will get on board in February, jail health officials told Bay Area News Group. Contra Costa County officials said roughly 150 people already receive the medications daily in county jails, and they will fully implement the changes by the 2026 deadline.
With the new support from the state, Darryl Liu, an analyst at San Mateo County Correctional Health Services, said he plans to continue his years-long goal of ramping up access to buprenorphine and other opioid addiction medications.
“CalAim has been a huge godsend,” Liu said.
A former police officer in Los Angeles, Liu said an experience on the job made him leave law enforcement and focus instead on treating addiction. When a sex worker arrived at the hospital desperate and seeking treatment, he said he had to arrest her after nurses searched her belongings and found hard drugs.
“I didn’t think that was appropriate,” he recalled.
At Maguire Correctional Facility, Liu has focused on shoring up access to medication assisted treatment since 2018. At that point, three people were receiving the treatment, he said. By December 2024, 46 were receiving buprenorphine, and Liu said that number will increase with the new Medi-Cal support.
Last month, Daniel White lifted up his red jail uniform to show a small node of medication the size of a walnut that protruded from his belly. It was a mass of Sublocade, which dissolves slowly over the course of a month as it time-releases buprenorphine.
White, 44, has long relied on an oral version of buprenorphine to stay sober. Like Santiago, he’s spent most of his adult life behind bars.
“It all stems from drug use,” White said.
Although Liu and Taylor say they’ve made progress, both acknowledged that their efforts are only reaching a fraction of those who need medication to treat opioid use disorders.
Statewide, two-thirds of people in jails and prisons require some kind of treatment for a substance use disorder, according to the California Department of Health Care Services. In December, 3% of the county’s jail population was receiving Sublocade, according to records.
“I always feel like we’re not doing enough,” Taylor said.
For Santiago, though, the future is looking unusually bright. On a recent Monday at Maguire, the San Francisco native said he’s savoring a life without the urge to use fentanyl or other illicit opioids, thanks to his monthly shot of Sublocade.
Lately he’s imagined starting a new life of sobriety with his girlfriend, who is homeless and using drugs in the Tenderloin neighborhood in San Francisco.
The goal?
“A better life,” he said.