Implementing a Jail-Based Buprenorphine Program in a Small Appalachian Facility: Insights From CFIR and ERIC

Abstract

Opioid use disorder is prevalent among incarcerated populations, who face elevated overdose risk post-release. Although effective, buprenorphine remains underutilized in U.S. jails, particularly in the South. This mixed-methods study evaluated clinical outcomes and implementation processes of a jail-based buprenorphine program in Appalachia. The State Department of Health piloted a model using telehealth prescribing and post-release navigation. Guided by the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change, qualitative interviews with five program staff identified implementation barriers and facilitators. Retention outcomes were strong and comparable to community benchmarks. Barriers included staff skepticism, stigma, limited capacity, and role ambiguity, while facilitators included sustained education, leadership engagement, and cross-agency collaboration. Findings demonstrate feasibility in resource-constrained southern settings and highlight strategies to sustain and expand buprenorphine access for justice-involved populations.