Journal of substance use and addiction treatment最新文献

{"title":"Healthcare usage and cost-effectiveness of approach bias modification at 12-months for patients undergoing inpatient withdrawal for alcohol use disorder","authors":"Nicola Huxley ,&nbsp;Joshua B.B. Garfield ,&nbsp;Anthony Harris ,&nbsp;Petra K. Staiger ,&nbsp;Dan I. Lubman ,&nbsp;Victoria Manning","doi":"10.1016/j.josat.2025.209834","DOIUrl":"10.1016/j.josat.2025.209834","url":null,"abstract":"<div><h3>Introduction</h3><div>There is evidence that approach bias modification (ApBM), a type of computerised cognitive training delivered during inpatient alcohol withdrawal treatment, significantly reduces relapse rate. Our analysis examines, for the first time, whether ApBM is cost-effective compared to sham-trained controls.</div></div><div><h3>Methods</h3><div>Patients at four inpatient withdrawal units were randomized to four daily sessions of ApBM, or sham (control) training. Self-reported data on alcohol use, treatment, and healthcare use was collected over 12-months. We conducted a trial-based cost-effectiveness study of ApBM (versus no ApBM) from a health system perspective. Costs were from relevant Australian 2022 sources. We estimated incremental differences between groups in healthcare costs and abstinence rates using mixed generalised linear models.</div></div><div><h3>Results</h3><div>At 12 months after discharge from the index withdrawal treatment episode, two thirds of participants had accessed acute health care services (i.e., inpatient withdrawal, ambulance, emergency department and hospital inpatient). Results generally indicated non-significant increases in cumulative costs ($6747, 95%CI: -$7743, $21,237; <em>p</em> = .361) at 12 months for the ApBM group versus controls. The incremental cost of ApBM versus no intervention for 12 months of continuous abstinence was $201,610, with confidence limits ranging from ApBM being less costly and more effective to more costly and less effective than no ApBM.</div></div><div><h3>Conclusion</h3><div>Although there was evidence of improved abstinence rates in the first 3-months post-discharge, delivering ApBM during acute alcohol withdrawal treatment will not likely generate net benefits over a 1-year period at any willingness-to-pay threshold, due to the continued heavy use of healthcare services in this population. Future research should test whether additional ApBM delivered post-discharge (e.g., via smartphone apps) could extend its relapse prevention effects and ultimately result in cost savings in the long-term.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209834"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shattering the STIGMA: Talking openly about MOUD in 12-step recovery programs","authors":"Steven Klein ,&nbsp;Juan Franco ,&nbsp;Adam Scioli","doi":"10.1016/j.josat.2025.209829","DOIUrl":"10.1016/j.josat.2025.209829","url":null,"abstract":"<div><div>Despite overwhelming evidence supporting Medications for Opioid Use Disorder (MOUD) for substance use disorders (SUDs), stigma persists within recovery communities—particularly in some circles of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)—that view Medications as incompatible with sobriety. This perspective piece explores the tension between life-saving pharmacologic interventions such as MOUD and deeply held beliefs within 12-step fellowships. Through the lens of a clinically grounded, narrative-driven, and first-person perspective we examine the origins of this stigma, including the historical ambivalence toward psychiatric medication in AA's founding literature. We also examine contemporary NA literature especially as it relates to the term “clean.” While many 12-step programs have increasingly accepted medications like antidepressants, MOUD remains stigmatized despite its proven effectiveness in reducing cravings, relapse, and overdose deaths. We argue that this resistance—often reinforced by sponsors, literature, and group norms—places patients at risk and undermines recovery. We use our personal experience as physicians and people in long-term recovery to call for a renewed interpretation of fellowship principles that embrace evidence-based treatment and affirms each individual's path to recovery. True sobriety should not require choosing between medication and belonging.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209829"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersecting challenges: Substance use and mental health disparities across self-reported disability status","authors":"Jessica Williams ,&nbsp;Xiao Li ,&nbsp;Hannah S. Szlyk ,&nbsp;Erin Kasson ,&nbsp;Nathaniel A. Dell ,&nbsp;Alex Ramsey ,&nbsp;Patricia A. Cavazos-Rehg","doi":"10.1016/j.josat.2025.209857","DOIUrl":"10.1016/j.josat.2025.209857","url":null,"abstract":"<div><h3>Purpose</h3><div>Substance use and substance use disorders (SUD) disproportionately affect people with disabilities (PWD), yet PWD remain under-represented in addiction treatment literature. While recent work has begun to address SUD prevalence and recovery service gaps, little is known about how disability status shapes substance use outcomes. The present study is the first to our knowledge to investigate how recovery, mental health comorbidities, and barriers to care differ across disability status using structured survey data from people who use substances.</div></div><div><h3>Methods</h3><div>333 participants who use substances and provided information about their disability status in the baseline survey for a digital intervention study were included in the analysis (Mean_Age: 41.1 (10.6); 58.0 % female; 68.2 % White). Bivariate analyses—independent sample <em>t</em>-tests and Chi-Square tests—were conducted to examine differences across disability status in recent substance use patterns, mental health comorbidities, recovery history, and barriers to treatment. Multivariable regression models were used to assess associations between disability status and variables of interest, adjusting for socio-demographic covariates.</div></div><div><h3>Results</h3><div>Of the participants, 34.2 % reported having a disability (<em>n</em> = 114). PWD were more likely to be of color, unemployed, insured, and older, compared to those without disabilities (<em>n</em> = 219; ps ≤0.001). Regression analyses indicated that PWD had significantly higher odds of using cannabis, alcohol, stimulants, and other drugs over past 30-day (aORs ranged 2.22–2.30). PWD also had higher odds of endorsing depression, anxiety, and lifetime suicide attempts (aORs ranged from 2.39 (anxiety) to 3.38 (depression)). Additionally, PWD perceived more barriers to substance use treatment (β: 0.55 (0.24)) and reported more overdoses (aOR (95 % CI): 2.60 (1.49, 4.54)) and prior recovery attempts (aOR: 2.69 (1.55, 4.68)), compared to those without disabilities.</div></div><div><h3>Conclusions</h3><div>This study is among the first to use quantitative survey data to assess and compare substance use and treatment engagement among PWD and their non-disabled peers. Findings underscore urgent equity gaps in SUD treatment systems and the importance of incorporating disability-informed frameworks in clinical assessments and recovery services. These insights complement recent qualitative findings and emphasize the need for inclusive, accessible, and person-centered care approaches in substance use health services and research.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209857"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Filling in the gaps: A geospatial approach to optimizing placement of methadone clinics in Massachusetts","authors":"Olivia Lewis ,&nbsp;Sumeeta Srinivasan ,&nbsp;Ric Bayly ,&nbsp;Jack Cordes ,&nbsp;Shikhar Shrestha ,&nbsp;Max R. O'Reilly ,&nbsp;Simeon D. Kimmel ,&nbsp;Alexander Y. Walley ,&nbsp;Hermik Babakhanlou-Chase ,&nbsp;Thomas J. Stopka","doi":"10.1016/j.josat.2025.209848","DOIUrl":"10.1016/j.josat.2025.209848","url":null,"abstract":"<div><h3>Introduction</h3><div>Methadone treatment dispensed at opioid treatment programs (OTPs) reduces the risk of fatal opioid-related overdose. Access to OTPs is limited in many regions. We utilized location-allocation models to identify gaps in OTP services across Massachusetts and generated descriptive statistics to further prioritize areas for expansion of services for socially vulnerable communities.</div></div><div><h3>Methods</h3><div>We used a geographic information system to generate eight location-allocation models, tools to target the placement of new sites based on the distribution of existing sites and demand for services, with a goal of identifying gaps in geographic access to OTPs. We identified potential new OTP locations using 15- and 30-minute walk- and drive-times, considering the location of existing OTPs. We used opioid-related incident (ORI) locations and overdose decedent residences to measure methadone demand. We ranked suggested OTPs for each model by how many ORIs or decedent residences they could serve as the nearest OTP. We calculated mean Social Vulnerability Index scores, population density, fatal opioid-related overdose rates, and ORI rates for census tracts within a 30-minute walk of each suggested site. We also ran supplementary location-allocation analyses that ignored the locations of existing OTPs.</div></div><div><h3>Results</h3><div>Our models consistently recommended new OTP service locations to address unmet needs in the Roxbury and Dorchester neighborhoods of Boston, Lowell, Pittsfield, New Bedford, Gardner, Quincy, Malden, Peabody, Falmouth, Nantucket, and Martha's Vineyard, Massachusetts. Of all suggested new treatment centers, those in Boston, Gardner, Peabody, and Lowell could serve as the closest OTP for the most ORIs or decedent residences. Suggested new OTPs in Boston, Gardner, Springfield, Quincy, New Bedford, and Lowell were in areas with high social vulnerability. Our walk-time models suggested sites in areas with higher community-level social vulnerability than our drive-time models. Areas with existing OTPs had higher average social vulnerabilities than suggested new OTP locations. Location-allocation models that ignored existing OTPs still suggested OTP locations close to current methadone clinics.</div></div><div><h3>Conclusions</h3><div>Through our location-allocation models and vulnerability assessments, we recommended potential locations for new OTPs to provide increased methadone access within areas of high fatal overdose and ORI burden. Results can inform data-to-action expansion of OTP access.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209848"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"C2: editorial board","authors":"","doi":"10.1016/S2949-8759(25)00249-8","DOIUrl":"10.1016/S2949-8759(25)00249-8","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209870"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the communities that HEAL intervention on the provision of jail-based medication for opioid use disorder & linkage programs at release: Results from a randomized, wait-list controlled trial","authors":"Carrie B. Oser ,&nbsp;Joel G. Sprunger ,&nbsp;Tim Hunt ,&nbsp;JaNae Holloway ,&nbsp;Redonna K. Chandler ,&nbsp;Bridget Freisthler ,&nbsp;Peter Balvanz ,&nbsp;Brandy F. Henry ,&nbsp;LaShawn Glasgow ,&nbsp;Daniel R. Harris ,&nbsp;Sharon L. Walsh ,&nbsp;Arnie P. Aldridge ,&nbsp;Kat Asman ,&nbsp;Derek Blevins ,&nbsp;Marisa D. Booty ,&nbsp;Aaron D. Fox ,&nbsp;Sandra A. Springer ,&nbsp;Elizabeth N. Kinnard ,&nbsp;Charles Knott ,&nbsp;Patricia A. LeBaron ,&nbsp;Peter D. Friedmann","doi":"10.1016/j.josat.2025.209835","DOIUrl":"10.1016/j.josat.2025.209835","url":null,"abstract":"<div><h3>Introduction</h3><div>This article examines whether the Communities That HEAL (CTH) intervention implemented by the HEALing (Helping to End Addiction Long-term®) Communities Study (HCS) expanded Medication for Opioid Use Disorder (MOUD) in jails and linkage to MOUD upon release.</div></div><div><h3>Methods</h3><div>Communities were randomized to the CTH intervention group (N = 34) to implement an integrated set of community coalition-selected evidence-based practices or to the wait-list control group (N = 33). A three-wave survey of jail administrators assessed changes in jails' provision of OUD-related services. Community-level generalized estimating equation (GEE)-based Poisson models regressed the effect of the CTH intervention on whether a community's jail (1) inducts clients onto MOUD and (2) links to MOUD on release.</div></div><div><h3>Results</h3><div>At baseline, more wait-list control communities' jails, compared to intervention communities' jails, inducted people on MOUD (75.9 % vs 63.3 %) and linked to MOUD upon release (79.3 % vs 66.7 %). During the evaluation period (July 2021 to June 2022), 71.0 % of CTH jails inducted people on MOUD (compared to 63.3 % at baseline), and 90.3 % of CTH jails linked persons to MOUD on release (compared to 66.7 % at baseline). Adjusted analyses detected no significant effect of the CTH intervention on MOUD induction or linkage.</div></div><div><h3>Conclusions</h3><div>Most CTH communities implemented linkage programs in jails. Compared to wait-list control communities, intervention communities' jails showed no difference in providing MOUD. Community coalitions can play an important role in facilitating MOUD linkage during reentry.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209835"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retention among Medicaid beneficiaries in opioid treatment programs in California","authors":"William N. Dowd ,&nbsp;Daniel H. Barch ,&nbsp;Tami L. Mark ,&nbsp;Chelsea Katz ,&nbsp;Barrett W. Montgomery ,&nbsp;Dylan DeLisle ,&nbsp;Thanh T. Lu ,&nbsp;Gary A. Zarkin","doi":"10.1016/j.josat.2025.209837","DOIUrl":"10.1016/j.josat.2025.209837","url":null,"abstract":"<div><h3>Background</h3><div>Continuing medications for opioid use disorders (MOUD) for an extended period is important to achieve good outcomes, but many patients do not remain in treatment for even six months. The goal of this study was to develop and describe case-mix adjusted retention rates among California Opioid Treatment Programs (OTP).</div></div><div><h3>Methods</h3><div>We developed measures of 30-, 90-, and 180-day retention using data from the California Outcomes Management System for Medicaid beneficiaries admitted as an outpatient to an OTP between July 1, 2021 and June 30, 2022. We applied case-mix adjustment to the measures to ascertain whether differences in patient characteristics drive differences in OTP-level retention rates and assessed the proportion of total variance in retention rates attributable to differences between OTPs. Finally, we identified statistically underperforming and overperforming OTPs relative to expected retention based on case-mix and described the potential impact of improvement among underperforming OTPs on overall retention rates.</div></div><div><h3>Results</h3><div>The average case-mix adjusted OTP-level retention rate (N = 131 OTPs) at 30 days was 76 % (range: 45 %–99 %), at 90 days was 54 % (range: 32 %–91 %), and at 180 days was 40 % (range: 8 %–85 %); only 18 % of OTPs retained at least half of their patients for at least 180 days. The distribution of case-mix adjusted and unadjusted measures was similar, indicating that variation in retention rates was explained by factors other than patient demographic and clinical baseline characteristics. Measures were shown to reliably indicate differences between OTPs across all retention periods, with between-OTP variance accounting for no less than 87 % of total variance in the median OTP. We showed that increasing retention among statistically underperforming OTPs to levels expected given their case-mix would result in an additional 4 %, 5 %, and 7 % of patients retained for 30, 90, and 180 days, respectively.</div></div><div><h3>Conclusion</h3><div>There is considerable room for improvement in retention. The wide range of retention rates at the OTP level after case-mix adjustment suggests that such improvements are attainable. Efforts should be made to support dissemination of successful strategies to improve retention among OTPs. Policymakers should explore opportunities to facilitate improvement, such as enacting quality reporting programs for OTPs.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209837"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Another one bite the dust—It happens so much in Black neighborhoods”: Structural barriers and grassroots resources among Black men who use drugs facing fentanyl-era overdose and treatment disparities","authors":"Devin E. Banks ,&nbsp;Kaytryn D. Campbell ,&nbsp;Maria E. Paschke ,&nbsp;Rashmi Ghonasgi ,&nbsp;Bridget Coffey ,&nbsp;Jameala Jones ,&nbsp;Brittany Blanchard ,&nbsp;Ryan W. Carpenter ,&nbsp;Daje Bradshaw ,&nbsp;Rachel P. Winograd","doi":"10.1016/j.josat.2025.209846","DOIUrl":"10.1016/j.josat.2025.209846","url":null,"abstract":"<div><h3>Introduction</h3><div>Black men in the United States have been disproportionately impacted by fatal drug overdose since the proliferation of synthetic opioids like fentanyl. This community based participatory research study examined determinants of overdose risk and substance use treatment disparities among Black men based on their lived experience.</div></div><div><h3>Methods</h3><div>Between February and December 2023, we enrolled 35 Black men reporting past-30-day opioid use to complete semi-structured qualitative interviews. Interviews were analyzed by a team of academic and community-based coders with lived experience using an inductive—deductive approach to thematic analysis.</div></div><div><h3>Results</h3><div>Six key themes were identified. Four themes described racism-related inequities posing overdose and comorbid risks to health and social wellness: (1) social stigma and isolation, (2) pervasive exposure to deadly drugs and overdose, (3) disproportionate exposure to trauma and societal consequences, and (4) gaps in health-related services and resources. Two themes addressed grassroots strategies Black men who use drugs employ to reduce harm and maintain wellness: (5) safe practices in drug purchasing, drug use, and overdose response, and (6) positive community and social supports.</div></div><div><h3>Conclusions</h3><div>Findings demonstrate how structural inequities like neighborhood segregation and economic deprivation interact with racial and substance use stigma, leading to daily experiences of social isolation, trauma, and fentanyl exposure for Black men. Findings extend previous research by illustrating how Black men work in and outside of systems to maintain wellness despite these vulnerabilities. Reducing the burden of overdose among Black men requires policy efforts that redress resource deprivation in Black neighborhoods and builds upon existing grassroots efforts and lived experience.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209846"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Shattering the STIGMA: Talking openly about MOUD in 12-step recovery programs” [Journal of Substance Use and Addiction Treatment, 181 (2026) 209829]","authors":"Steven Klein ,&nbsp;Juan Franco ,&nbsp;Adam Scioli","doi":"10.1016/j.josat.2025.209859","DOIUrl":"10.1016/j.josat.2025.209859","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209859"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing evidence-based treatment for pregnant people with opioid use disorder in jail: A qualitative analysis of jail administrator and clinician perspectives","authors":"Carolyn Sufrin ,&nbsp;Camille Kramer ,&nbsp;Kevin A. Fiscella ,&nbsp;Cosima Lenz ,&nbsp;Chanel Lee ,&nbsp;Jill Marsteller","doi":"10.1016/j.josat.2025.209855","DOIUrl":"10.1016/j.josat.2025.209855","url":null,"abstract":"<div><h3>Introduction</h3><div>Overdose is a leading cause of maternal mortality in the United States, and pregnant individuals with opioid use disorder (OUD) frequently interact with the criminal legal system. While the benefits of providing life-saving medications for opioid use disorder (MOUD) during pregnancy are well-established, access to MOUD in jail remains limited and inconsistent. Although existing literature identifies general barriers to MOUD implementation in incarcerated settings, the specific needs of pregnant individuals are often overlooked. Our study assessed the perspectives of jail custody and medical leaders to examine pregnancy-specific MOUD implementation barriers and facilitators.</div></div><div><h3>Methods</h3><div>From September 2019 to September 2020, we conducted semi-structured qualitative interviews with jail administrators and clinicians across the United States. Interview questions were organized around domains of the Consolidated Framework of Implementation Research (CFIR) framework to explore contextual elements of jails' provision of care to pregnant patients with OUD. We performed a CFIR-informed, directed content analysis to identify key themes and determinants for pregnancy MOUD implementation in jails.</div></div><div><h3>Results</h3><div>We interviewed 28 individuals from 23 jails, 18 of which offered either full or modified MOUD in pregnancy. Our pregnancy-focused, CFIR analysis identified three main themes: (1) pregnancy introduced unique challenges and opportunities for MOUD implementation in jails; (2) concerns about ensuring fetal wellbeing strongly and positively influenced jails' decisions and approaches to providing MOUD in pregnancy, and discontinuing MOUD postpartum; and (3) stigma, judgment, and limited understanding of substance use and MOUD during pregnancy were widespread and significantly negatively shaped implementation efforts.</div></div><div><h3>Conclusion</h3><div>Study findings highlight the nuances of implementing pregnancy-specific MOUD and the complex care needs of pregnant and postpartum individuals in custody. Both jail custody and medical leaders expressed varying levels of concern for this population, which influenced their treatment approaches. Leveraging their concern for fetal wellbeing could be a critical determinant in encouraging implementation of pregnancy and postpartum MOUD in jails. Successfully implementing and sustaining pregnancy MOUD in jails requires tailored strategies that improve education around maternal-fetal-newborn wellbeing, strengthen infrastructure, and reduce stigma. As jail-community partnerships work to expand MOUD in custody, they must tend to perinatal specific needs in order to optimize maternal and infant health.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209855"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}