PROJECT SUMMARY/ABSTRACT The NIDA K23 Award proposes innovative research in opioid use disorder (OUD) treatment linkage after release from incarceration. Recently incarcerated individuals are at significantly increased risk for overdose death. Despite the clear benefits of medications for opioid use disorder (MOUD), uptake is low among individuals with criminal-legal involvement (CLI). A critical knowledge gap that remains is how to overcome the multiple structural barriers to post-release treatment engagement that lead to overdose-related morbidity and mortality for this marginalized population. Telehealth-delivered buprenorphine may address gaps in provider availability, competing social determinants of health, and access inequities related to buprenorphine treatment. Interventions utilizing telehealth must be targeted to the specific needs of individuals with CLI and engage relevant stakeholders across correctional and community settings. The objective of this application is to develop a tele-buprenorphine clinical protocol to improve post-release treatment engagement. Specific aims include:1) Identify rates and predictors of post-release buprenorphine treatment linkage among individuals with OUD after jail incarceration; 2) Examine the perspectives of individuals with OUD and CLI, clinicians, and administrators to inform the development of a tele-buprenorphine protocol for low-threshold treatment linkage among jail-released adults; and 3) Conduct a pilot randomized-controlled trial utilizing tele-buprenorphine for post-release treatment linkage among adults with OUD upon release from jail. An Intervention Mapping protocol incorporating input from relevant stakeholders will be utilized to develop the intervention. These aims will identify the target population and assess the needs and objectives of stakeholders, support the development and testing of study measures, and assess the feasibility, acceptability, and preliminary efficacy of the intervention. The proposed research will lead to an R01 randomized controlled trial to test the impact of tele-buprenorphine on post-incarceration OUD treatment linkage, retention, and CLI outcomes. The mentorship team brings together experts in health equity, health services research, clinical trials, addiction medicine, substance use epidemiology, and correctional health care, as well as stakeholder advisors from correctional health and reentry settings. This award will allow Dr. Utsha Khatri to develop as a clinician-investigator through the pursuance of four training goals: 1) Develop advanced knowledge of correctional health care and addiction treatment care transitions during reentry 2) Acquire advanced quantitative skills for clinical outcome assessment using linked, administrative datasets 3) Design and conduct clinical trials on care delivery interventions to address the needs of marginalized groups and 4) Attain grant writing and project management skills to transition to independence. With the successful completion of this project, training activities, and mentorship from a team of experienced investigators, Dr. Khatri will be exceptionally well prepared to lead an independent research agenda designed to improve care and outcomes for individuals with CLI and addiction.

PROJECT NARRATIVE Amidst the grave and worsening national overdose crisis, individuals with a history of recent incarceration face significant barriers to receiving evidenced-based medication and are at increased risk for death when compared to the general population. Telehealth is one potential strategy to address gaps in treatment clinician availability, competing social determinants of health, and access inequities by providing flexible, low-cost, and low-threshold access to treatment linkage after release from incarceration. This study will identify predictors of failed post-release treatment engagement among individuals with recent incarceration and intervene with a telehealth innovation, which has great potential to decrease overdose mortality and improve health outcomes for this marginalized population.