Even with substantial efforts at the state and local levels, opioid overdoses in Illinois continue to rise. Many in jails and prisons suffer from opioid use disorders and some receive treatment. Upon release, the risk of overdose is enhanced due to reduced tolerance. This article presents findings from a survey of 36 Illinois jail administrators on the use of medication-assisted treatment for detainees with opioid use disorders, naloxone distribution to reduce post-release overdose, and policies to ensure safe withdrawal from opioids and other drugs.