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

Provision of medications for opioid use disorder (MOUD) programs in carceral settings is critical to reducing overdose during the high-risk period following release from incarceration. Efforts to expand carceral MOUD programs have increased in recent years. We conducted a narrative review to synthesize evidence on the implementation of MOUD in U.S. carceral facilities. We analyzed 36 studies from 2019 to 2023 using the Exploration, Preparation, Implementation, Sustainment framework. Findings highlight that MOUD in carceral settings requires significant resources, infrastructure, and staffing. MOUD diversion is a common concern, with program responses varying widely. Stigma against MOUD remains a challenge, particularly when treating pregnant people with OUD. Effective coordination between carceral and community stakeholders is critical for MOUD implementation and continuity of treatment postrelease. COVID-19 spurred innovation, increasing telehealth in carceral MOUD programs. Future research should explore MOUD program transition from early adoption to wide-scale implementation, considering external factors, sustainability, and evolving policies.