Social-ecological factors shape preferences for and receipt of medications to treat opioid use disorder in the post-incarceration period

Providing medications to treat opioid use disorder (MOUD) in carceral and community settings improves health outcomes. However, limited research has examined patient preferences for different MOUD types and delivery mechanisms or the factors (e.g., stigma) that shape these preferences. These knowledge gaps hinder improvements in treatment outcomes, particularly during the post-incarceration period when risk of overdose and treatment discontinuation is high. In 2025, 28 adults in the Northeast who had received MOUD during a past year incarceration and were engaged post-release completed an in-depth one-on-one interview. Interviews were transcribed and analyzed using template thematic analysis informed by the social-ecological model. Participants were, on average, released from incarceration 5 months before the interview, and most (n=25) were receiving methadone at that time. Four themes were generated according to social-ecological levels. First, perceived MOUD benefits motivated current continuation of treatment, with most intending to taper off within the next year. Second, participants placed minimal value on and had limited experience receiving interpersonal support for MOUD from family and friends. Few described receiving beneficial instrumental support (e.g., transportation). Third, community/organizational-specific factors, such as transportation access and clinic practices, contributed to participants’ reevaluation of their MOUD continuity plans. Fourth, federal MOUD regulations (e.g., take-home methadone access) and social drivers (e.g., stigma) were salient factors that often reduced perceived MOUD options in the post-release period. Individuals must navigate multiple systems to continue MOUD post-incarceration and weigh multilevel factors when making MOUD continuation decisions. Program adaptations that acknowledge patient preferences and long-term goals are needed to minimize care gaps.