Provision of medications for opioid use disorder (MOUD) programs in carceral settings is critical to reducing overdose during the high-risk period following release from incarceration. Efforts to expand carceral MOUD programs have increased in recent years. We conducted a narrative review to synthesize evidence on the implementation of MOUD in U.S. carceral facilities. We analyzed 36 studies from 2019 to 2023 using the Exploration, Preparation, Implementation, Sustainment framework. Findings highlight that MOUD in carceral settings requires significant resources, infrastructure, and staffing. MOUD diversion is a common concern, with program responses varying widely. Stigma against MOUD remains a challenge, particularly when treating pregnant people with OUD. Effective coordination between carceral and community stakeholders is critical for MOUD implementation and continuity of treatment postrelease. COVID-19 spurred innovation, increasing telehealth in carceral MOUD programs. Future research should explore MOUD program transition from early adoption to wide-scale implementation, considering external factors, sustainability, and evolving policies.
AaronsG. A.HurlburtM.HorwitzS. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health, 38(1), 4–23. https://doi.org/10.1007/s10488-010-0327-7
2.
BandaraS.Kennedy-HendricksA.MerrittS.BarryC. L.SalonerB. (2021). Methadone and buprenorphine treatment in United States jails and prisons: Lessons from early adopters. Addiction, 116(12), 3473–3481. https://doi.org/10.1111/add.15565
3.
BarnesC. A.PonceA. N.LoewyR. (2021). Recommendations to Improve Medication-Assisted Treatment Implementation in Correctional Health. Psychiatric Services, 72(2), 233–234. https://doi.org/10.1176/appi.ps.202000527
4.
BinswangerI. A.BlatchfordP. J.MuellerS. R.SternM. F. (2013). Mortality after prison release: Opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009. Annals of Internal Medicine, 159(9), 592–600. https://doi.org/10.7326/0003-4819-159-9-201311050-00005
5.
BinswangerI. A.SternM. F.DeyoR. A.HeagertyP. J.CheadleA.ElmoreJ. G.KoepsellT. D. (2007). Release from prison—A high risk of death for former inmates. The New England Journal of Medicine, 356(2), 157–165. https://doi.org/10.1056/NEJMsa064115
6.
BlueT. R.FletcherJ. B.MonicoL. B.GordonM. S.SchwartzR. P.MitchellS. G. (2023). Jail and treatment staff attitudes regarding MOUDs before and after an implementation intervention. Journal of Offender Rehabilitation, 62(7), 411–426. https://doi.org/10.1080/10509674.2023.2246446
7.
BootyM. D.HarpK.BattyE.KnudsenH. K.StatonM.OserC. B. (2023). Barriers and facilitators to the use of medication for opioid use disorder within the criminal justice system: Perspectives from clinicians. Journal of Substance Use and Addiction Treatment, 149, 209051. https://doi.org/10.1016/j.josat.2023.209051
8.
Brinkley-RubinsteinL.PetersonM.ClarkeJ.MacmaduA.TruongA.PognonK.ParkerM.MarshallB. D. L.GreenT.MartinR.SteinL.RichJ. D. (2019). The benefits and implementation challenges of the first state-wide comprehensive medication for addictions program in a unified jail and prison setting. Drug and Alcohol Dependence, 205, 107514. https://doi.org/10.1016/j.drugalcdep.2019.06.016
9.
CatesL.BrownA. R. (2023). Medications for opioid use disorder during incarceration and post-release outcomes. Health & Justice, 11(1), 4. https://doi.org/10.1186/s40352-023-00209-w
10.
ChengA.BadolatoR.SegoshiA.McDonaldR.MaloneM.VasudevanK.BadieiB.SugarmanA.MacdonaldR.MangatJ.GiftosJ.LeeJ. D.TofighiB. (2022). Perceptions and experiences toward extended-release buprenorphine among persons leaving jail with opioid use disorders before and during COVID-19: An in-depth qualitative study. Addiction Science & Clinical Practice, 17(1), 4. https://doi.org/10.1186/s13722-022-00288-4
11.
ClarkK. J.VechinskiJ.MolfenterT.TaxmanF. S. (2023). Cascade of care in the legal system: Best practices and goals for agencies providing care to patients concurrently navigating substance use disorders and criminal legal involvement. Journal of Drug Issues, 55(1), 64–88. https://doi.org/10.1177/00220426231196304
12.
DonelanC. J.HayesE.PoteeR. A.SchwartzL.EvansE. A. (2021). COVID-19 and treating incarcerated populations for opioid use disorder. Journal of Substance Abuse Treatment, 124, 108216. https://doi.org/10.1016/j.jsat.2020.108216
13.
DuncanA.SandersN.SchiffM.WinkelmanT. N. A. (2021). Adaptations to jail-based buprenorphine treatment during the COVID-19 pandemic. Journal of Substance Abuse Treatment, 121, 108161. https://doi.org/10.1016/j.jsat.2020.108161
14.
EvansE. A.PivovarovaE.StopkaT. J.SantelicesC.FergusonW. J.FriedmannP. D. (2022). Uncommon and preventable: Perceptions of diversion of medication for opioid use disorder in jail. Journal of Substance Abuse Treatment, 138, 108746. https://doi.org/10.1016/j.jsat.2022.108746
15.
EvansE. A.WilsonD.FriedmannP. D. (2022). Recidivism and mortality after in-jail buprenorphine treatment for opioid use disorder. Drug and Alcohol Dependence, 231, 109254. https://doi.org/10.1016/j.drugalcdep.2021.109254
16.
FergusonW. J.JohnstonJ.ClarkeJ. G.KoutoujianP. J.MaurerK.GallagherC.WhiteJ.NicklD.TaxmanF. S. (2019). Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails. Health & Justice, 7(1), 19. https://doi.org/10.1186/s40352-019-0100-2
17.
Flanagan BalawajderE.DucharmeL.TaylorB. G.LamudaP. A.KolakM.FriedmannP. D.PollackH. A.SchneiderJ. A. (2024). Factors associated with the availability of medications for opioid use disorder in US jails. JAMA Network Open, 7(9), e2434704. https://doi.org/10.1001/jamanetworkopen.2024.34704
GrellaC. E.OstileE.ScottC. K.DennisM.CarnavaleJ. (2020). A scoping review of barriers and facilitators to implementation of medications for treatment of opioid use disorder within the criminal justice system. The International Journal on Drug Policy, 81, 102768. https://doi.org/10.1016/j.drugpo.2020.102768
20.
GrellaC. E.ScottC. K.DennisM. L.LaValleeR. A. (2023). Access to services for pregnant people with opioid use disorder in jails in the United States. Journal of Correctional Health Care: The Official Journal of the National Commission on Correctional Health Care, 29(4), 299–307. https://doi.org/10.1089/jchc.22.03.0023
21.
HannaJ.KubiakS.PasmanE.GabaA.AndreM.SmelsonD.PinalsD. A. (2020). Evaluating the implementation of a prisoner re-entry initiative for individuals with opioid use and mental health disorders: Application of the consolidated framework for implementation research in a cross-system initiative. Journal of Substance Abuse Treatment, 108, 104–114. https://doi.org/10.1016/j.jsat.2019.06.012
22.
HarringtonC.BaileyA.DelormeE.HanoS.EvansE. A. (2023). “And then COVID hits”: A qualitative study of how jails adapted services to treat opioid use disorder during COVID-19. Substance Use & Misuse, 58(2), 266–274. https://doi.org/10.1080/10826084.2022.2155480
23.
HartungD. M.McCrackenC. M.NguyenT.KempanyK.WaddellE. N. (2023). Fatal and nonfatal opioid overdose risk following release from prison: A retrospective cohort study using linked administrative data. Journal of Substance Use and Addiction Treatment, 147, 208971. https://doi.org/10.1016/j.josat.2023.208971
KangA.BaileyA.NapoleonS.MartinR. (2023). Contextualizing medications for opioid use disorder and peer support service provision in the probation system with implementation science. Research Square. https://doi.org/10.21203/rs.3.rs-3607705/v1
KaplowitzE.TruongA. Q.BerkJ.MartinR. A.ClarkeJ. G.WieckM.RichJ.Brinkley-RubinsteinL. (2022). Treatment preference for opioid use disorder among people who are incarcerated. Journal of Substance Abuse Treatment, 137, 108690. https://doi.org/10.1016/j.jsat.2021.108690
30.
KaplowitzE.TruongA. Q.MacmaduA.BerkJ.MartinH.BurkeC.RichJ. D.Brinkley-RubinsteinL. (2023). Anticipated barriers to sustained engagement in treatment with medications for opioid use disorder after release from incarceration. Journal of Addiction Medicine, 17(1), 54–59. https://doi.org/10.1097/ADM.0000000000001029
31.
KawasakiS.HwangG.BucknerK.FrancisE.HuffnagleS.KraschnewskiJ.VulgamoreP.LucasA.BarbourJ.CrawfordM.ThomasL.FullerM.MeyersJ.SwartzentruberG.LevineR. (2022). Collaborative health systems ECHO: The use of a tele-education platform to facilitate communication and collaboration with recipients of state targeted response funds in Pennsylvania. Substance Abuse, 43(1), 892–900. https://doi.org/10.1080/08897077.2021.2007519
32.
KingZ.KramerC.LatkinC.SufrinC. (2021). Access to treatment for pregnant incarcerated people with opioid use disorder: Perspectives from community opioid treatment providers. Journal of Substance Abuse Treatment, 126, 108338. https://doi.org/10.1016/j.jsat.2021.108338
33.
KlempererE. M.WreschnigL.CrockerA.King-MohrJ.RamniceanuA.BrooklynJ. R.PeckK. R.RawsonR. A.EvansE. A. (2023). The impact of the implementation of medication for opioid use disorder and COVID-19 in a statewide correctional system on treatment engagement, postrelease continuation of care, and overdose. Journal of Substance Use and Addiction Treatment, 152, 209103. https://doi.org/10.1016/j.josat.2023.209103
34.
KrawczykN.BandaraS.MerrittS.ShahH.DuncanA.McEnteeB.SchiffM.AhmadN. J.WhaleyS.LatimoreA.SalonerB. (2022). Jail-based treatment for opioid use disorder in the era of bail reform: A qualitative study of barriers and facilitators to implementation of a state-wide medication treatment initiative. Addiction Science & Clinical Practice, 17(1), 30. https://doi.org/10.1186/s13722-022-00313-6
35.
LamJ. A.LeeH. I. S.TruongA. Q.MacmaduA.ClarkeJ. G.RichJ.BrockmannB. (2019). Brief video intervention to improve attitudes throughout medications for opioid use disorder in a correctional setting. Journal of Substance Abuse Treatment, 104, 28–33. https://doi.org/10.1016/j.jsat.2019.06.001
36.
LudwigA.MonicoL. B.BlueT.GordonM. S.SchwartzR. P.MitchellS. G. (2022). Development and use of a checklist for the implementation of medication for opioid use disorder in jails. Implementation Research and Practice, 3, 26334895221101214. https://doi.org/10.1177/26334895221101214
37.
MacArthurG. J.MinozziS.MartinN.VickermanP.DerenS.BruneauJ.DegenhardtL.HickmanM. (2012). Opiate substitution treatment and HIV transmission in people who inject drugs: Systematic review and meta-analysis. BMJ, 345, Article e5945. https://doi.org/10.1136/bmj.e5945
38.
MacmaduA.GoedelW. C.AdamsJ. W.Brinkley-RubinsteinL.GreenT. C.ClarkeJ. G.MartinR. A.RichJ. D.MarshallB. D. L. (2020). Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails. Drug and Alcohol Dependence, 208, 107858. https://doi.org/10.1016/j.drugalcdep.2020.107858
39.
MartinM.PhillipsM. A.SaxonM.LoveK.CessnaL.WoodardD. L.PageM.CurryK.PaoneA.Pennington-StallcupB.RileyW. (2021). Recovery support specialists inside the jail: A program description of treatment engagement for opioid use disorder. International Journal of Prisoner Health, 17(4), 497–508. https://doi.org/10.1108/IJPH-12-2020-0102
MatsumotoA.SantelicesC.EvansE. A.PivovarovaE.StopkaT. J.FergusonW. J.FriedmannP. D. (2022). Jail-based reentry programming to support continued treatment with medications for opioid use disorder: Qualitative perspectives and experiences among jail staff in Massachusetts. The International Journal on Drug Policy, 109, 103823. https://doi.org/10.1016/j.drugpo.2022.103823
42.
National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Sciences Policy, Committee on Medication-Assisted Treatment for Opioid, MancherM.LeshnerA. I. (2019). The Effectiveness of Medication-Based Treatment for Opioid Use Disorder. Medications for Opioid Use Disorder Save Lives. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK541393/
National Commission on Correctional Health Care & National Sheriffs’ Association. (2025). Jail guidelines for the medical treatment of substance use disorders 2025. National Commission on Correctional Health Care. https://www.ncchc.org/jail-based-mat/
PivovarovaE.EvansE. A.StopkaT. J.SantelicesC.FergusonW. J.FriedmannP. D. (2022). Legislatively mandated implementation of medications for opioid use disorders in jails: A qualitative study of clinical, correctional, and jail administrator perspectives. Drug and Alcohol Dependence, 234, 109394. https://doi.org/10.1016/j.drugalcdep.2022.109394
48.
PivovarovaE.TaxmanF. S.BolandA. K.SmelsonD. A.LemonS. C.FriedmannP. D. (2023). Facilitators and barriers to collaboration between drug courts and community-based medication for opioid use disorder providers. Journal of Substance Use and Addiction Treatment, 147, 208950. https://doi.org/10.1016/j.josat.2022.208950
49.
PourtaherE.GelbergK. H.FallicoM.EllendonN.LiS. (2023). Expanding access to Medication for Opioid Use Disorder (MOUD) in jails: A comprehensive program evaluation. Journal of Substance Use and Addiction Treatment, 161, 209248. https://doi.org/10.1016/j.josat.2023.209248
50.
RanapurwalaS. I.ShanahanM. E.AlexandridisA. A.ProescholdbellS. K.NaumannR. B.EdwardsD.MarshallS. W. (2018). Opioid overdose mortality among former North Carolina inmates: 2000-2015. American Journal of Public Health, 108(9), 1207–1213. https://doi.org/10.2105/AJPH.2018.304514
RyanD. A.MontoyaI. D.KoutoujianP. J.SiddiqiK.HayesE.JengP. J.CadetT.McCollisterK. E.MurphyS. M. (2023). Budget impact tool for the incorporation of medications for opioid use disorder into jail/prison facilities. Journal of Substance Use and Addiction Treatment, 146, 208943. https://doi.org/10.1016/j.josat.2022.208943
53.
SaundersE. C.SatcherM. F.MonicoL. B.McDonaldR. D.SpringerS. A.FarabeeD.GryczynskiJ.NyakuA.ReevesD.KunkelL. E.SchultheisA. M.SchwartzR. P.LeeJ. D.MarschL. A.WaddellE. N. (2022). The impact of COVID-19 on the treatment of opioid use disorder in carceral facilities: A cross-sectional study. Health & Justice, 10(1), 35. https://doi.org/10.1186/s40352-022-00199-1
ScottC. K.GrellaC. E.DennisM. L.CarnevaleJ.LaValleeR. (2022). Availability of best practices for opioid use disorder in jails and related training and resource needs: Findings from a national interview study of jails in heavily impacted counties in the U.S. Health & Justice, 10(1), 36. https://doi.org/10.1186/s40352-022-00197-3
56.
SolomonA. L.MooreK. F.McLearenA. M., & Office of Justice Programs Bureau of Justice Assistance. (2023). Guidelines for managing substance withdrawal in jails: A tool for local government officials, jail administrators, correctional officers, and health care professionals. U.S. Department of Justice Office of Justice Programs. https://bja.ojp.gov/doc/guidelines-managing-substance-withdrawal-jails.pdf
StatonM.PikeE.TillsonM.LofwallM. R. (2023). Facilitating factors and barriers for use of medications to treat opioid use disorder (MOUD) among justice-involved individuals in rural Appalachia. Journal of Community Psychology, 52(8), 997–1014. https://doi.org/10.1002/jcop.23029
59.
StopkaT. J.RottapelR. E.FergusonW. J.PivovarovaE.Toro-MejiasL. D.FriedmannP. D.EvansE. A. (2022). Medication for opioid use disorder treatment continuity post-release from jail: A qualitative study with community-based treatment providers. The International Journal on Drug Policy, 110, 103803. https://doi.org/10.1016/j.drugpo.2022.103803
SufrinC.KramerC. T.TerplanM.FiscellaK.OlsonS.VoegtlineK.LatkinC. (2023). Availability of medications for opioid use disorder in U.S. jails. Journal of General Internal Medicine, 38(6), 1573–1575. https://doi.org/10.1007/s11606-022-07812-x
62.
SufrinC.KramerC. T.TerplanM.FiscellaK.OlsonS.VoegtlineK.LatkinC. (2022). Availability of medications for the treatment of opioid use disorder among pregnant and postpartum individuals in US jails. JAMA Network Open, 5(1), e2144369. https://doi.org/10.1001/jamanetworkopen.2021.44369
63.
SufrinC.SutherlandL.BealL.TerplanM.LatkinC.ClarkeJ. G. (2020). Opioid use disorder incidence and treatment among incarcerated pregnant women in the United States: Results from a national surveillance study. Addiction, 115(11), 2057–2065. https://doi.org/10.1111/add.15030
ThakrarA. P.AlexanderG. C.SalonerB. (2021). Trends in Buprenorphine Use in US Jails and Prisons From 2016 to 2021. JAMA Network Open, 4(12), e2138807. https://doi.org/10.1001/jamanetworkopen.2021.38807
66.
ThomasS.SingerA.KopakA. (2023). Receptivity to Jail-based medication for opioid use disorder among rural detention Administrators. Corrections, 9(4), 517–535. https://doi.org/10.1080/23774657.2023.2278195
67.
TreitlerP. C.EnichM.ReevesD.CrystalS. (2022). Medications for opioid use disorder in state prisons: Perspectives of formerly incarcerated persons. Substance Abuse, 43(1), 964–971. https://doi.org/10.1080/08897077.2022.2060448
68.
VictorG.LeeG.PozoB.del SilversteinS.ZettnerC.CasonR.RayB. (2022). Medications for opioid use disorder in the criminal/legal system: Knowledge, beliefs, and attitudes among rural community-based stakeholders. Journal of Drug Issues, 52(3), 389–405. https://doi.org/10.1177/00220426221076800
69.
WhaleyS.BandaraS.TaylorK.KrawczykN. (2023). Expanding buprenorphine in U.S. jails: One county’s response to addressing the fears of diversion. Journal of Substance Use and Addiction Treatment, 146, 208944. https://doi.org/10.1016/j.josat.2022.208944
70.
ZielinskiM. J.AllisonM. K.Brinkley-RubinsteinL.CurranG.ZallerN. D.KirchnerJ. A. E. (2020). Making change happen in criminal justice settings: Leveraging implementation science to improve mental health care. Health & Justice, 8(1), 21. https://doi.org/10.1186/s40352-020-00122-6
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
