Perceived impacts of medications for opioid use disorder implementation on mental health services and substance use counseling in carceral settings: qualitative findings from 13 Massachusetts jails.

BACKGROUND: Although research on Medications for Opioid Use Disorder (MOUD) in carceral settings has grown, it has largely focused on the implementation of medication delivery or on substance use outcomes in the community. However, the introduction of new programs or the expansion of treatment services in criminal legal settings can have both direct and indirect consequences on other treatment programs and correctional operations within jails. Mental health and substance use disorders frequently co-occur, and their psychosocial treatment components often overlap. We examined how the implementation of MOUD in all jails across Massachusetts impacted the mental health services operating within the jails and the requirements for substance use counseling alongside MOUD. METHODS: We conducted semi-structured interviews (n = 47) and focus groups (n = 42) with staff from 13 county jails as part of an implementation of MOUD in jails study. Using deductive and inductive coding, all transcripts were double-coded and analyzed using a modified framework method. RESULTS: We identified five key themes about the perceived impact of MOUD on mental health and substance use counseling services. First, MOUD implementation was perceived to reduce acute mental health crises, such as risk for suicide, and the demand on mental health services at intake to the facility. Second, staff perceptions about the effectiveness of MOUD as a stand-alone treatment influenced their decisions about the need for and interpretation of substance use counseling requirements. Third, the required components of substance use counseling created a need for additional staff, which exacerbated the existing shortage of mental health staff. Fourth, infrastructure limitations and privacy needs made the delivery of substance use counseling logistically challenging in jail settings. Finally, MOUD implementation increased interdisciplinary collaboration in some jails by requiring medical, mental health, and substance use providers to work together to resolve the needs of incarcerated individuals. CONCLUSIONS: As jails aim to meet regulatory requirements for MOUD, they will need to manage potential staffing shortages, infrastructure constraints, and shifts in the mental health and substance use counseling services. Guidelines for implementing MOUD in carceral settings should also consider the unintended consequences of MOUD on other behavioral health services.