Implementation of Jail and Prison-Based Medication Treatment for Opioid Use Disorder Programs: A Narrative Synthesis.

Area of Science:

• Public Health
• Addiction Medicine
• Criminal Justice Health

Background:

• Medications for Opioid Use Disorder (MOUD) are crucial for reducing overdose deaths post-incarceration.
• Increasing efforts focus on expanding MOUD programs within carceral settings.
• Evidence synthesis is needed to understand MOUD implementation in U.S. carceral facilities.

Purpose of the Study:

• To synthesize evidence on the implementation of MOUD in U.S. carceral facilities.
• To identify facilitators and barriers to carceral MOUD program implementation.
• To inform future strategies for effective MOUD delivery in correctional settings.

Main Methods:

• Narrative review of 36 studies published between 2019 and 2023.
• Analysis guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
• Synthesis of findings related to resources, diversion, stigma, and stakeholder coordination.

Main Results:

• Carceral MOUD programs require substantial resources, infrastructure, and staffing.
• MOUD diversion is a prevalent concern with varied programmatic responses.
• Stigma, especially for pregnant individuals, and the need for post-release continuity of care are significant challenges.
• COVID-19 accelerated telehealth adoption in carceral MOUD programs.

Conclusions:

• Successful carceral MOUD implementation hinges on adequate resources, addressing diversion and stigma, and robust coordination with community partners.
• Ensuring continuity of care post-release is critical for sustained recovery.
• Future research should focus on scaling up MOUD programs and navigating policy and sustainability.