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

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.