With the removal of many structural barriers to MOUD at RIDOC for eligible individuals, MOUD stigma may be one of the most important remaining barriers impeding MOUD uptake and engagement. However, even when structural barriers to MOUD are removed (i.e., high cost, lack of access, lack of trained providers), not all eligible individuals elect to initiate MOUD treatment ( Booth, Corsi, & Mikulich, 2003 Booth, Kwiatkowski, Iguchi, Pinto, & John, 1998 Uebelacker, Bailey, Herman, Anderson, & Stein, 2016). The Rhode Island Department of Corrections (RIDOC) recently became the first statewide correctional system in the US to implement a comprehensive MOUD program ( Clarke, Martin, Gresko, & Rich, 2018 Green et al., 2018), making the three FDA-approved MOUD options (methadone, buprenorphine, and naltrexone) available to all clinically eligible individuals. Implementing MOUD in correctional populations has extensive benefits, including reductions in illicit opioid-use post-incarceration ( Kinlock, Gordon, Schwartz, Fitzgerald, & O'Grady, 2009 Mattick, Breen, Kimber, & Davoli, 2009), criminal behavior ( Deck et al., 2009), HIV risk behaviors ( MacArthur et al., 2012), and overdose risk ( Brinkley-Rubinstein et al., 2018 Degenhardt et al., 2011 Kerr et al., 2007). Growing evidence suggests that medications for opioid use disorder (MOUD) are an effective, evidence-based approach to address OUD in correctional populations ( Green et al., 2018 National Academies of Sciences, 2019 Sharma et al., 2016). Criminal justice (CJ) involved individuals have a greater burden of OUD and are at substantially increased risk of overdose death following reentry to the community ( Binswanger, Blatchford, Lindsay, & Stern, 2011 Binswanger, Blatchford, Mueller, & Stern, 2013 Binswanger et al., 2007 Farrell & Marsden, 2008 Merrall et al., 2010). Opioid use disorder (OUD) and opioid-related mortalities are critical public health challenges in the United States.
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