Medications for opioid use disorders among incarcerated persons and those in the community supervision setting: exploration of implementation issues with key stakeholders

Introduction: Receipt of medications for opioid use disorder (MOUD) critically reduces opioid-related mortality during the post-incarceration period. Optimal provision of this care to individuals on community supervision (i.e., probation) requires an understanding of this unique and complex system at the local level.

Methods: We conducted in-depth individual interviews with key treatment providers and probation staff (n = 10) involved with the provision of MOUD to individuals on community supervision in the Northeast. Interviews explored perspectives on the provision of MOUD and support services during the community supervision period. Thematic analysis was conducted to describe inductive and deductive codes, subcodes, and themes.

Results: Stakeholders shared diverse attitudes about the benefits and drawbacks of MOUD utilization. The provision of MOUD during the community supervision period was perceived to be influenced by both treatment and probation organizational characteristics, including the structures and values of the agencies. As such, the specific context of the community supervision setting facilitated and impeded MOUD delivery. Persistent challenges to enhancing MOUD delivery to this population remain including widespread MOUD stigma, inter-agency communication issues, and structural barriers to healthcare (i.e., transportation, finances).

Conclusions: There are opportunities to enhance access to evidence-based OUD treatment for persons on community supervision by engaging probation agencies and community treatment staff in systems change.