Patient preferences for medications to treat opioid use disorder in carceral settings: Implications for tailored implementation and service delivery.

backgroundA critical lack of knowledge exists about incarcerated individuals' preferences for the provision of medications to treat opioid use disorder (MOUD) in carceral settings (i.e., jail, prison) and of multilevel factors that influence preferences (e.g., health needs, institutional policies). This gap limits the ability to tailor MOUD programs effectively to patient needs and optimize outcomes within correctional systems.

methodsIn 2025, 28 adults receiving MOUD in the community in the Northeastern United States and who previously received MOUD while incarcerated completed an in-depth, semi-structured interview. Transcripts were generated and then coded using template thematic analysis. The social-ecological model informed the interview guide and analysis.

resultsDuring their most recent incarceration, most participants received methadone (64.3%), one-fourth received sublingual buprenorphine, and the remaining first received buprenorphine then switched to methadone (10.7%). Four themes corresponding to social-ecological levels were developed. First, the context of the carceral environment underlies the MOUD experience while incarcerated, wherein the use of surveillance measures influenced participant experiences of the MOUD program. Second, the delivery of MOUD was affected by logistical complications that influenced MOUD course and could result in participants switching MOUD type or intending to stop MOUD use in the future. Third, MOUD-focused interactions were most often with correctional officers and peers and less often with medical personnel, sometimes resulting in information gaps and perceived stigma magnification. Fourth, withdrawal alleviation and medication maintenance motivated the desire to receive any MOUD while incarcerated, while side effects and knowledge affected the selection of MOUD type. Patients advocated for specific organizational and structural changes to reduce difficulties and enhance comfort and safety (e.g., reducing delays to dosing at intake).

conclusionsWhile incarcerated, patient MOUD preferences are informed by several factors spanning social-ecological levels that allow MOUD receipt with more ease (i.e., quicker receipt at intake) and flexibility (i.e., dose changes), and fewer negative interpersonal and individual experiences (i.e., poor interactions, withdrawal, side effects). Patient-guided treatment adaptations have the potential to reach and sustain more patients, advancing equitable provision of MOUD in correctional systems.