Timothy York knows what works to treat his decadeslong opioid addiction: Suboxone, a medication that effectively quiets cravings. Since York arrived in federal prison in 2008, he has been held in a series of facilities awash with contraband drugs and violence. Yet the federal prisons are treating only a fraction — less than 10% — of the roughly 15,000 prisoners who need it, according to the bureau’s estimates. Some say the issues stem from a culture at the bureau that is skeptical of addiction medication and pits staff against prisoners. He was using an underground supply of Suboxone at USP-Coleman, the federal prison in Florida where he was incarcerated, but it was erratic.

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