Barriers to Medication-Assisted Treatment for Opioid Use Disorder in Prisons and Jails in the United States: A Comprehensive Literature Review

Background: The American Society for Addiction Medicine guidelines state that all FDA-approved medication for opioid use disorder should be available for all patients (CDC, 2024). Medication-assisted treatments for opioid use disorders, also known as medication for opioid use disorder (MOUD), are treatments that help diminish the physical symptoms of addiction to opioids. Currently, there are three FDA-approved medications to treat opioid use disorder: buprenorphine, methadone, and naltrexone (FDA, 2024). Despite being at an increased risk for opioid misuse and overdose, incarcerated individuals in the U.S. often do not have access to MOUD. This comprehensive literature review aimed to determine the prevailing barriers to MOUD programs in carceral facilities. Methods: A comprehensive literature search approach was conducted across five databases and scholarly search tools, resulting in 41,395 records from the initial search. The review followed systematic review principles and adhered to a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A thematic review process using Zotero reference manager and modified MAPiT strategy provided additional analysis and insights, resulting in ten final studies to analyze. Results: Applying search refinement criteria of the research resulted in (n = 8) qualitative studies that gathered data through interviews, focus groups, surveys, or a combination of these methods—all included studies that identified at least two types of MOUDs. Half of the study settings included only jails (n = 5), less than half (n = 4) included unified jails and prisons, and only one study was limited to just a prison. Study participants in eight of the studies were representatives of the carceral settings, such as administrators, clinicians, or staff—two studies utilized incarcerated individuals as study participants. The identified barriers were categorized into four thematic groups: program, stigma, regulatory, and community barriers. Conclusion: Despite societal evidence supporting MOUD, many compounding and interdependent barriers such as policy, geography, staffing issues, and resources prevent carceral institutions from adopting best practices for opioid use treatment. Reducing these barriers to MOUD for incarcerated individuals would save thousands of lives every year from overdose.