<p>Opioid use disorder (OUD) represents a&#xa0;significant public health issue, with individuals in custody being disproportionately affected by this substance use disorder. In recent decades, the treatment of OUD has undergone a&#xa0;fundamental paradigm shift. Abstinence-oriented treatment approaches have increasingly been replaced by opioid maintenance treatment (OMT). The latter aims to reduce health-related harm due to substance use disorder and to improve the quality of life.</p><p>According to the principle of equivalence of care, medical care provided in prison must match the standard of care available in the general community. The goal of this study is to examine the implementation of OMT in German prisons, to identify existing challenges and to outline perspectives and suggestions for improvement.</p><p>We conducted a&#xa0;selective literature search focusing on OMT within the context of German correctional institutions. Our findings indicate that despite positive developments OMT is overall insufficiently provided for incarcerated individuals. An improved access to OMT could reduce the risk of renewed incarceration, lower drug-related mortality and support reintegration efforts. It is still unclear from current research results how long these effects last, especially in Germany. In Germany the substitution rate among opioid-dependent people in the general population is currently estimated at about 49%, which is below the EU average. Among opioid-dependent male prisoners it is assumed that only about 30–40% receive OMT. To ensure an equivalent standard of care, we explore prison-specific challenges in the management of OUD. In this context, we advocate the increased use of long-acting formulations of buprenorphine as they require less frequent administration, are resistant to misuse and reduce the risk of an overdose (particularly following release from custody). Although initially more costly these formulations can save time and staff resources in the long term.</p>