In one interview study of Massachusetts jail staff following a state law mandating provision of all methadone, buprenorphine, and naltrexone, staff described that arranging for continued methadone dosing following release was particularly difficult due to staff's lack of knowledge regarding availability and access to methadone in the community. This was particularly difficult given that methadone must be dosed in person daily, and follow-up must therefore occur within one day of being released. Interviews with hospital-based providers cited similar confusion around where to refer patients following discharge.

Interviews with jail-based providers have highlighted the sudden paradigm shift that comes with providing opioid replacement medications such as buprenorphine or methadone to inmates, given that the carceral system traditionally views drugs as illegal or contraband and frames the relationship between inmate and staff as adversarial rather than cooperative. Hospital-based providers attempting to implement methadone initiation programs during hospitalization have voiced similarly stigmatizing prior beliefs that substance use and substance use disorder are self-inflicted, moral failings.

Interviews with hospital-based providers cite confusion surrounding who can provide methadone and in what settings, with many providers unaware that they could order and dose methadone during hospitalization. This confusion partly stems from federal regulations that state that methadone can be initiated in the hospital only if a patient is hospitalized for a medical condition other than opioid use disorder (e.g., for the treatment of an infection).