Medication for Opioid Use Disorder in Jail Settings: Barriers and Facilitators to Implementation

Abstract

Individuals are at particularly high risk for opioid overdose following release from incarceration. While providing medications for opioid use disorder (MOUD) inside carceral facilities is a promising approach to reducing this risk, it remains under-utilized in these settings. Our primary aim was to identify barriers and facilitators of implementing MOUD programs in jails. We conducted qualitative, semi-structured interviews with 14 stakeholders (e.g., jail staff, health providers) involved in the management, planning, implementation, and linkage to care post-release of the MOUD program in one North Carolina jail in 2020 and 2021. We then conducted thematic analysis using a general inductive approach. Themes included barriers to implementation and approaches to overcome these challenges. Barriers to MOUD implementation included a lack of continuity of care between community and jail settings and stigma against MOUD. However, multiple approaches can overcome such barriers: fostering collaborations bridge carceral and non-carceral settings to ensure individuals receive high quality and continuous care and providing peer support and navigation post-release. This study provides important insight into the functioning of a MOUD program within a Southern jail that is the product of community- and state-wide partnerships. To improve health and reduce recidivism, it is important for MOUD programs to be implemented in jails across the country, based in meaningful cross-sector collaborations and peer support services.