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.
Background: Incentive programs are an effective yet underutilized behavioral intervention that can improve outcomes in medication for opioid use disorder (MOUD) treatment. Contingency Management (CM) is a rigorous incentive program run per seven evidence-based principles (e.g. objectively verifiable target behaviors, frequent opportunities for incentives). Prior implementation attempts have focused on implementing CM in specialized addiction clinics with methadone as the primary medication treatment. However, many people get MOUD from less specialized, more accessible family medicine clinics. These clinics might also benefit from the use of incentive programs, yet present unique challenges for implementation. For example, family medicine clinics typically use buprenorphine as their primary medication, which requires less intensive dosing schedules than methadone and thus provides fewer incentive opportunities. As an initial step in user-centered design of a CM-informed incentive program for the family medicine context, we conducted qualitative interviews with patients and staff in the buprenorphine treatment program of a family medicine department. We gathered and analyzed qualitative data on CM knowledge, preferred program parameters, and implementation considerations.
Method: Participants (N = 24) were buprenorphine treatment staff (n = 12) and patients (n = 12). Participants completed 30-50-minute semi-structured interviews, analyzed using rapid matrix analysis.
Results: Participants had little experience with formal incentive programs, but generally viewed incentives as acceptable, appropriate, and feasible. Interviewees coalesced around having staff who were not MOUD prescribers run the program, consistent rather than escalating payments, and physical rewards delivered in-person. Potential challenges included medical record integration, demands on staff time, and confirmation of patients' goal completion.
Conclusions: Patient and staff feedback was well-aligned, especially regarding rewards as an opportunity for staff-patient connection and the need for simplicity. Comparing end-user suggestions with the literature, some consensus suggestions (e.g. non-escalating rewards) highlighted feasible places to compromise on ideal effectiveness to gain implementability. However, others (e.g. use of self-report to verify goals) conflicted directly with CM principles and indicate where more intensive education, support, and monitoring will be needed for implementation fidelity. These findings inform user-centered design and iteration of an incentive program for this accessible, non-specialized family medicine setting.
Background: Exercise interventions have been shown to effectively reduce drug craving and improve physical and mental health in patients with substance use disorders (SUDs). However, the optimal type and amount of exercise needed to maximize these benefits for SUDs is not fully understood and warrants further investigation.
Methods: A comprehensive search strategy was implemented in four electronic databases (i.e., PubMed, Web of Science, CNKI, and EMBASE) to identify randomized controlled trials examining the impact of exercise on craving in individuals with substance use disorders. Network meta-analysis and dose-response modeling were employed to assess the specific benefits of exercise on craving.
Results: The analysis incorporated a total of 30 randomized controlled trials, encompassing a total of 1,717 subjects. These subjects were comprised of 1,258 male participants (73.26%) and 459 female participants (26.73%). The results of the meta-analysis demonstrated that there was a low grade GRADE evidence suggesting that, in comparison with the control group, aerobic exercise (SMD= -0.73, 95%CI: -1.06 to -0.41), high-intensity interval exercise (SMD= -2.19, 95%CI: -3.90 to -0.49), and aerobic combined with resistance exercise (SMD= -1.96, 95%CI: -2.92 to -1.00) were more effective than the control group. Subgroup analyses revealed positive effects of acute aerobic exercise (SMD= -0.23, 95%CI: -0.41 to -0.04, I²=22%) and long-term aerobic exercise (SMD= -0.46, 95%CI: -0.72 to -0.21, I²=0%) on cravings. Furthermore, the results found that Taijiquan significantly reduced drug craving (SMD= -0.47, 95%CI: -0.70 to -0.24, I²=0%) in the subjects. The dosage analysis revealed that the effective range of total exercise for reducing craving in individuals with substance use disorder was from 20 to 320 METs-min/week (SMD= -0.58, 95%CI: -0.8 to -0.28 to SMD= -0.72, 95%CI: -0.91 to -0.46). The optimal form of exercise was determined to be aerobic exercise, with an optimal exercise dose of 180 METs-min/week, which resulted in an estimated mean difference of -1.46 (95%CI: -2.04 to -0.96). The regression analysis results indicated that the impact of exercise on subjects' cravings may be influenced by their age level (β= -0.995, 95%CI: -2.002 to -0.011).
Conclusion: Aerobic exercise has been recognized as the most effective form of exercise for alleviating drug cravings in individuals with substance use disorders (SUDs). Research indicates that the exercise dose for SUDs exhibits characteristics of low-dose effectiveness and plateaus in its effects. The optimal total intervention dose is best sustained at 180 METs-min/week, which is equivalent to three 60-minute sessions of moderate-intensity aerobic exercise each week.
Clinical trial registration details: Not applicable.
Prospero registration details: CRD420251004497.
Introduction: Successful implementation of peer recovery coach (PRC) programs may help improve linkage to services and clinical outcomes for emergency department (ED) patients with substance use disorder (SUD). However, literature on implementation outcomes and strategies of PRC programs is limited. We conducted a qualitative assessment of implementation outcomes and strategies for an ED-based PRC program in Atlanta, Georgia.
Methods: We conducted qualitative interviews with 27 program participants (ED patients with SUD served by PRC program) and 29 service providers and partners (peer recovery coaches, ED physicians and staff, SUD treatment and other service providers) in October 2023 - March 2025. We transcribed audio-recordings and analyzed data using rapid qualitative analysis approach mapping emerging themes to Proctor's model of implementation outcomes and Leeman et al.'s implementation strategies framework.
Results: We identified two major themes related to implementation outcomes: (1) PRC program acceptability (patients' positive interactions with PRCs) and (2) appropriateness (sub-themes include: successful linkage to community services; PRC program as an important resource for patients; added value of PRC team; no negative impact on ED workflow). Themes related to implementation strategies include (1) streamlined communication between PRC and ED teams (direct communication via electronic medical records system, single contact phone number, informing ED service providers of clinical and program outcomes), (2) addressing barriers to community-based services (preparing patient's medical documentation, insurance, transportation to community services); (3) supportive supervision of PRCs (addressing daily and long-term issues through regular meetings; limiting caseload; and providing orientation, on-job training and mental health support) and (4) addressing telehealth implementation challenges (ensuring access to electronic medical records system).
Conclusion: This study outlines key implementation outcomes and strategies for PRC programs, offering practical guidance for successful ED-based PRC program implementation.
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