Long-acting Buprenorphine vs. Naltrexone Opioid Treatments in CJS-involved Adults

Inclusion Criteria:

XR-B vs. XR-NTX Inclusions:

• (1) Adult volunteer aged 18 years or older able to provide written informed consentin English (or Spanish at some sites)

• (2) Current CJS incarceration (residing in a controlled environment) with pendingrelease date (within 6 months of randomization) OR community CJS-involvement definedas: a) Current CJS incarceration (residing in a controlled environment) with pendingrelease date (within 6 months of anticipated randomization), or; b)Community-dwelling volunteers with current CJS-involvement. [Current CJS-involvementis defined as either 1) release from any CJS incarceration or detention, or 2) undercommunity supervision (includes parole, probation, drug or other treatment court, orother alternative to incarceration supervision) within 6 months prior to studyenrollment (the date of a signed ICF)].

• (3) Current or history of moderate-to-severe opioid use disorder in the past yearprior to incarceration (OUD, DSM-5)

• (4) Not planning to move out of state or to new location within 6-monthspost-release (reasonable chance they can complete 6 months of follow-up visits).

• (5) Willing to accept either XR-B or XR-NTX assignment.

Non-randomized TAU Inclusions:

• Recruited prior to launch of RCT or not interested in or appropriate for randomization to XR-B or XR-NTX assignment (i.e, already on methadone pre-release), but are otherwise eligible based on inclusion (#1-4, above) and exclusion (#6-10, below).

Exclusion Criteria:

XR-B vs. XR-NTX Exclusions:

• (6) Medical or psychiatric disorders making participation unsafe or regularfollow-up unlikely, (such as suicidal ideation or pre-existing moderate to severehepatic impairment)

• (7) Pregnancy, planning conception, or breast-feeding

• (8) Allergy, hypersensitivity or medical contraindication to either medication

• (9) Chronic pain requiring opioid pain management

• (10) On daily stable methadone or buprenorphine (SL-B) maintenance every day forpast 30 days prior to incarceration or monthly XR-NTX or XR-BUP 30 days or longerprior to incarceration AND intending to remain on same form of methadone orbuprenorphine or XR-NTX maintenance now and upon return to the community (i.e., wasin MOUD treatment pre-incarceration, on same MOUD treatment now, and plans tocontinue same MOUD treatment post-incarceration). (Note - If community-dwelling,already on non-study methadone, buprenorphine, or naltrexone for 30 days or longerat the time of enrollment, and planning on continuing same.)

Non-randomized TAU Exclusions:

• Currently treated with non-study MOUD while currently incarcerated and for 30+ days prior to incarceration, or, if community-dwelling, currently on MOUD for 30 days or longer at the time of enrollment.