"So What's Gonna Happen when I Get out of Here?" Qualitative Barriers and Facilitators to MOUD Continuity Post-Release from Jail

Background Medication for opioid use disorder (MOUD) treatment is increasingly available within jails, but little is known about patient experiences regarding treatment continuity post-release. Methods Between 2021 and 2022, we interviewed 38 recently-released people who received MOUD in Massachusetts county jails. We asked participants about their experiences with reentry and MOUD continuity post-release. Thematic analyses were framed by the social-ecological model. Results At the individual-interpersonal level, participants reported the importance of self-advocacy during incarceration to plan for post-release MOUD treatment continuity. They cited increasing awareness of diminished opioid tolerance as a risk factor for post-release overdose. Participants reported hopelessness about recovery when returning to communities saturated with substance use-related triggers. Participants recognized social support systems as crucial. At the organizational level, participants reported variation by facility in reentry assistance. Detail-oriented reentry teams, active outreach, follow through, clear communication, caring attitudes, and early initiation of reentry planning were key to filling gaps in treatment post-release. Community-level themes emphasized the importance of communication between jail staff and community providers to schedule appointments and provide transportation. At the policy level, advanced reentry planning is needed to avoid treatment lapses, including assistance with health insurance reactivation and bridge prescriptions during the transition from jail-based to community-based MOUD. Conclusion Participants recognized the high risk of MOUD treatment lapses during transitions from jail to community reentry, and valued MOUD continuity services initiated during incarceration and continued post-release. Variation in patient-reported quality of reentry planning services underscored the need for more standardized investment in re-entry and treatment continuity services.