Opioid use remains a significant public health concern in America. The epidemic further resulted in significant increases in justice-involved persons with a history of opioid use with as much as 15% of incarcerated persons having an Opioid Use Disorder. The literature describes pharmacotherapies for opioid use in combination with counseling as the gold standard for treating Opioid Use Disorder (OUD). Elizabeth Detention Facility, a 300-bed Immigration and Customs Enforcement ICE) Health Service Corps (IHSC) facility, noted increases in requests to manage patients with active opioid use or a history of opioid pharmacotherapy. The facility leadership team began to develop local OUD treatment program using opioid pharmacotherapy and training to address staff confidence with managing the population. The Health Administrator and the Lead Pharmacist began by coordinating access to medication. We determined that IHSC's formulary included buprenorphine products. The pharmacist secured a supply of buprenorphine via our pharmaceutical supplier. The pharmacy and local leadership team developed procedures for securely storing, accounting, and dispensing the medication. This preparation proved prescient as correctional placement options for patients with OUD in the immediate vicinity diminished. As the political climate toward immigration shifted in the state, many local correctional facilities were no longer willing to house noncitizens. Our onsite psychiatrists led training on recognizing withdrawal symptoms for alcohol, benzodiazepine, and opioids. The Clinical Director provided additional training on the use of the Clinical Opioid Withdrawal Scale (COWS). The pharmacist provided training on the proper administration of the sublingual films to the nursing staff. Our staff physician obtained a buprenorphine waiver as a back-up provider. We included training to support clinical staff competence with managing patients in active withdrawal from OUD. Finally, a physician evaluated patients prior to leaving ICE custody or transitioning to another facility to ensure they had access to adequate medication and continuity of care. At the outset, our program goals included the introduction of an opioid detoxification program to our clinic. Moreover, the program ensured IHSC Elizabeth could meet local program needs given the shifting environment. The opioid detoxification program at IHSC Elizabeth resulted in a successful demonstration project at the facility. In conclusion, IHSC Elizabeth successfully provided opioid pharmacotherapy to 22 persons during 2023. The program ensured the provision of care that aligned with best practice recommendations for opioid detoxification treatment. As the opioid crisis continues to evolve and impact justice-involved persons, due consideration should be given to expanding capacity to manage this patient population in ICE detention health settings. Expanded capacity might include additional training to support staff competence and comfort, evidence-based clinical guidance, and access to medication in all ICE detention health settings.