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The delivery of health care is based on the theory that patients have timely access to qualified clinicians who will render a professional clinical judgment that is ordered and received. This article describes traditional barriers to opioid treatment and care to incarcerated populations. With 60 to 80 percent of current and former prisoners convicted on drug-related charges, the need to provide drug abuse treatment in jails and prisons remains a high social and clinical priority. The medical, economic, and social burden of opioid addiction can be alleviated with the expansion of addiction treatment programming in the criminal justice system. This article presents arguments why this programming should be implemented and describes national standards on how services should be organized. The article concludes with a description of the nursing role in a criminal justice substance abuse program highlighting key tasks that correctional nurses perform. The article concludes with a discussion of the future challenges and directions to opioid treatment in the criminal justice system.