Philadelphia's Jails Traded a $1,776-a-Month Shot for a $50 Pill. One in Three Patients Got Caught Diverting It.

Two years ago, Philadelphia's jail system had a problem it thought it had solved. People locked up in the city's facilities were being prescribed Suboxone for opioid use disorder, and roughly half of them, according to the jails' own longtime medical director, were being removed from the program for selling it, trading it, or giving it away.

The answer was a shot. Brixadi, a once-monthly injectable form of buprenorphine, removes the daily pill from the equation entirely. A pilot launched in November 2024 at Riverside Correctional Facility with 46 patients, was expanded to the intake jail and other facilities four months later, and by the time it ended had reached 563 people.

In June, the city stopped offering it. The reason was money, and the arithmetic is not in dispute: Brixadi cost $2,660 for the first month and $1,776 for each month after, against roughly $50 a month for the oral version of the same drug. The jails' addiction-treatment budget was $4.3 million, and the city overspent it by nearly $1 million. This year's budget for the program is about $2 million.

The diversion came back almost immediately. Of the 719 people prescribed Suboxone in city jails since the June switch, one in three has been caught misusing it, according to figures city officials provided to The Philadelphia Inquirer. They were tapered off the medication and left without addiction treatment, which is the same sequence the injection was introduced to break.

What the injection actually changed

The clinical logic behind depot buprenorphine in a custodial setting is simple to the point of being obvious. A daily film dissolves under the tongue and can be spat out, palmed, or sold. A depot injection sits in fatty tissue and releases over weeks. "I don't know how you divert a shot," Prisons Commissioner Michael Resnick said in an interview with the Inquirer.

A person familiar with the program, who was not authorized to speak publicly, estimated that the injections cut diversion by at least 30 percent. That estimate is the only outcome number the public has, because the city never published one, and the program was small enough that a formal evaluation would have been thin.

The pilot's expansion is the strongest evidence the city itself had: officials moved it into the intake jail within four months, which is where the population turns over fastest and where a single dose either anchors someone to treatment or does not. Between 1,200 and 1,400 people a year received Suboxone in the jails over the previous five years.

The math that left the city choosing

Percentages hide the shape of this decision, so it is worth spelling out. The city's jail medication-assisted treatment budget was $4.3 million and it ran roughly $1 million over. Divide that overspend by the $1,776 steady-state monthly cost of the injection and you get about 560 patient-months, which is close to one month of Brixadi for every one of the 563 people who ever received it. The program did not fail on price in the abstract. It ran out of room in a budget line.

The city's framing of the cost comparison is also worth a second look. Officials and the Inquirer describe the injection as costing "more than 50 times" the pill, which is true of the loading month, when $2,660 is measured against $50. At steady state the multiple is about 35. Either way the gap is enormous, and no read of the numbers makes the injectable look affordable inside a $2 million program.

Sharon Gallagher, a spokesperson for the Philadelphia Managing Director's Office, said Suboxone is "effective and the most cost-efficient option for the city, given available funding and rising medical expenses needed to treat all patient needs." She said jail medication policies have not changed and that officials "remain committed to ensuring that every person housed in our facilities who needs medication-assisted treatment receives it."

That commitment is doing a lot of work in a system where a third of the people on the oral medication have lost it. One in three of 719 is roughly 240 people, and the mechanism by which they lost access matters more than the count. Being caught diverting does not move a patient to the injection. It moves them to a taper and then to nothing.

The people who were shaken down for their doses

Not everyone caught with diverted Suboxone was running a trade. Some patients, the source told the Inquirer, were being shaken down by other prisoners for their doses. Those are precisely the people for whom a monthly injection works best and who now have no medication at all, because the jail's response to diversion is uniform: taper, then stop.

Resnick said the shots were effective and that the department is now trying to reduce diversion by housing people receiving opioid addiction treatment in the same units, on the theory that if everyone on a unit is on the same medication there is less incentive to sell it. Medical staff, he said, have been "extra vigilant" about watching people swallow their doses rather than hide them.

Sarah Bleiberg Bellos, an attorney with the Pennsylvania Institutional Law Project, told the Inquirer that Brixadi is not universally popular among incarcerated people. Some prefer Suboxone. Some get a skin reaction from the injectable. Her point is not that the city chose the wrong formulation but that the choice should belong to the patient, because everyone behind bars has a right to treatment for opioid use disorder "in the form that is the best fit for them."

Where the settlement money went instead

Philadelphia is not short of opioid money. In June, the same month it halved the jail treatment budget, the city directed roughly $151 million over five years to operations, programming and other costs at Riverview Wellness Village, a 336-bed city-run recovery home that opened in 2025, and Philly Home at Girard, a 180-bed low-barrier shelter that opened in 2024. Annualized, that commitment is about $30 million a year against the $2 million now budgeted for treatment inside the jails.

City officials say the two decisions were part of one conversation about prioritizing settlement spending, and Deputy Managing Director Crystal Yates-Gale, who oversees health and human services, rejected the idea that money was shifted from one population to another. Officials declined to say how many people have been treated at Riverview or Philly Home at Girard, citing patient privacy given the small numbers involved.

At a hearing last week of City Council's Committee on Legislative Oversight, at-large Councilmember and Minority Whip Nicolas O'Rourke asked what had happened to the injections and whether settlement funds had been "diverted to other administration priorities." He called incarceration "a public health challenge directly impacted by the care provided on the inside," noting that whether someone leaves jail still in treatment shapes their ability to rebuild a life.

A records fight that ended in an appeal

The reason the public numbers in this story exist at all is that the Inquirer asked for them and was refused. City officials did not respond for months. Only after the newspaper filed a right-to-know request, and appealed the city's partial denial, did the figures on funding and patient counts arrive, along with interviews with the decision-makers.

That reluctance is not unusual, and it is measurable.

Eight in nine jails say nothing

A Brown University-led research letter published Nov. 3 in JAMA Network Open found that only 396 of 2,920 U.S. jails, or 13.6 percent, had any public record confirming they offer medications for opioid use disorder. Prisons did somewhat better at 25.6 percent. Among jails with a public record, just 39.1 percent named methadone or buprenorphine, the two medications that activate opioid receptors and the two that carry the strongest evidence for reducing overdose deaths after release.

The authors describe their counts as lower bounds, since a jail can run a program it never posts online. The point is not that the other 86 percent provide nothing. It is that a family trying to find out whether a jailed relative will keep their medication has no reliable way to ask, which is how a treatment decision becomes a matter of luck and paperwork.

The clinical stakes of getting it wrong are documented. NIDA notes that people who stop using opioids while incarcerated lose much of their tolerance, and many return to their previous doses "not realizing their bodies can no longer tolerate the same doses." The weeks after release are among the most dangerous in a person's life. Giving people buprenorphine or methadone at release is associated with fewer overdose deaths in that window.

What the oversight hearing left open

The city signed a contract in May with a new jail healthcare provider, CFG Health, and the cost of addiction medications under that contract has not been determined. Resnick called the decision straightforward. "The math is simple," he said.

It is simple, and that is the problem. A jail system that can buy a monthly injection for 563 people or a daily pill for 1,400 is choosing between a cheaper medication that a third of its patients divert and a more expensive one that almost none do, inside a budget it has just cut in half while directing fifteen times as much settlement money to two facilities across town. Philadelphia's jails remain one of the few systems in Pennsylvania that let people start medication-assisted treatment behind bars at all, which is what makes the retreat from the injectable notable rather than routine.

For the roughly 1,700 people booked into city jails in 2024 who were treated for opioid addiction, the question the hearing did not answer is the one that matters at release: whether the city's next version of this program is designed around what keeps people in treatment, or around what keeps the budget line flat.