As modern medicine's understanding of addiction has matured the United States criminal justice system has not kept up with the program, and until very recently, the gulf between evidence-based best practice and practical reality been just as stark as the gulf between the United States and the rest of the world. Some experts have estimated that up to a quarter of those incarcerated have opioid-use disorder, with some of those addicts enrolled in methadone maintenance at the time of their arrest. But most jails and prisons around the country do not give inmates access to methadone or buprenorphine, two medications considered to be the gold standards for treatment of opioid-use disorder. There is ample scientific evidence demonstrating that certain types of prison-based drug treatment can substantially reduce recidivism. Yet most prisons don't even offer assistance in coordinating treatment entry for prisoners being released, let alone offer treatment behind bars. Most countries in Western Europe along with Australia have implemented methadone or buprenorphine programs within correctional facilities to reduce the risks associated with ongoing drug use in jail, and the risks associated with relapse and its consequences upon release. These include increased risk of overdose death, spread of HIV infection and - as mentioned above - criminal recidivism. Indeed, the World Health Organization has recommended opioid agonist treatment in prisons for more than a decade, and correctional facilities with treatment programs have found that they increase - not decrease - security within their facilities. In Europe opioid substitution treatment in prisons is reported by 28 of the 30 countries monitored by the European Monitoring Center for Drugs and Drug Addiction. Detoxification, individual and group counseling, and therapeutic communities or special inpatient wards are available in prisons in most countries, and infectious diseases testing is available in prisons in most countries. Critically, many European countries have partnerships between prison health services and providers in the community to ensure continuity of care on prison entry and release. In November 2018 U.S. District Judge Denise Casper issued a groundbreaking ruling, ordering that a county jail in Massachusetts must provide methadone to a prospective inmate so he can continue his opioid addiction treatment while incarcerated. The order stated that the denial of methadone medication could violate the Americans with Disabilities Act and the constitutional prohibition against cruel and unusual punishment. While Judge Casper’s preliminary injunction applies to only one man at one facility, the decision could have nationwide implications – potentially expanding or expediting the use of medication-assisted treatment for addicted inmates. The decision stemmed from a lawsuit brought by the ACLU of Massachusetts against the head of Essex County's House of Correction in Middleton, Massachusetts, and the county sheriff, on behalf of Geoffrey Pesce, who started taking methadone in 2016 to kick his addiction to heroin. Pesce was due to be sentenced for driving with a revoked or suspended license when the lawsuit was filed. Following the success of a pilot program in Franklin County's jail system, Massachusetts Governor Charlie Baker signed legislation in August 2018 to establish pilot medication-assisted treatment programs for inmates at correctional facilities in five counties, including Franklin. Essex County, however, was not among the counties included.