JMIR Publications

ABSTRACT

Background:

Individuals with opioid use disorder (OUD) who return to the community from incarceration face a high risk of fatal drug overdose. This mortality risk is related to significant barriers to accessing the healthcare, social support, and resources needed to transition to and thrive within the community safely. Digital health tools have effectively supported substance use treatment and recovery, but their potential to support OUD during the high-risk period of reentry is underexplored.

Objective:

To examine how adults with opioid use disorder (OUD) returning from incarceration perceive and engage with digital health tools, and identify barriers and facilitators to its use.

Methods:

Semi-structured interviews were conducted with a purposive sample of 39 adults recently released from New Hampshire prisons and jails. Participants were recruited from a randomized clinical trial (EXIT-CJS) comparing the effectiveness of extended-release buprenorphine, naltrexone, and enhanced treatment as usual on treatment retention. Interviews were audio-recorded, transcribed, and analyzed using deductive-inductive approach to content analysis. The COREQ criteria were used to guide the study reporting.

Results:

Most participants preferred digital health over in-person care for both OUD treatment and other healthcare, mainly due to its convenience and resilience against reentry challenges. Yet, most participants also underscored the irreplaceable role of in-person therapeutic human connection in recovery and recognized this as a detriment of stand-alone digital health. Participants described using digital health tools to overcome barriers that otherwise would have prevented them from receiving in-person care, such as transportation shortages, limited provider availability, and work scheduling conflicts. Accessing digital health was acknowledged as contingent on access to Internet-capable devices, affordable connectivity, and digital literacy.

Conclusions:

The findings suggest that maximizing digital health’s impact in reentry will require a multi-pronged approach: investing in infrastructure to close the digital divide, addressing upstream structural barriers to accessing care, and partnering with impacted persons to co-design hybrid care models that enhance the feasibility of engaging in care during reentry while enhancing therapeutic human connection and respecting patient preferences.