Advancing MOUD Options in Correctional Settings: Experiences from the EXIT-CJS Trial in Delaware

The JCOIN Clinical Research Center based at New York University School of Medicine is conducting a randomized clinical trial comparing the effectiveness of two long-acting injectable medications for opioid use disorder (MOUD): extended-release buprenorphine (Sublocade, XR-B) and extended-release naltrexone (XR-NTX). Individuals selected for this multi-site trial participated in treatment in community corrections, jail, and prison settings in New York, New Jersey, Delaware, New Hampshire, Connecticut, and Oregon. The study, titled Extended-Release Injectable Treatments in the Criminal Justice System (EXIT-CJS), recently completed recruiting and enrolling the justice-involved participants.

Friends Research Institute (FRI) led the effort to distribute extended-release injectable treatments (EXIT-CJS) in Delaware, with support from the Department of Corrections (DOC) and its medical contractors. To ensure participants made a fully informed decision about participating in the study, the research staff educated them about opioid use disorder (OUD), the medication and how it works, and the full range of available treatments. Embedded research staff maintained a regular presence and spent considerable time with the individuals to ensure potential participants had a solid understanding of their options, whether as part of the study or under the DOC’s existing medication policies. Recruitment presentations doubled as educational opportunities, with study staff providing accessible and succinct information about OUD and how different medications work. DOC permitted the research staff to have access to the dorms, which helped to ensure that individuals could regularly interact with the research staff. As study personnel became a fixture in the facility and a trusted resource, people routinely approached them to ask questions about addiction, treatment, and related issues.

Animated by principles of autonomy and respect, these direct interactions focused on ensuring individuals had equitable access to information and empowering individuals to make informed decisions about their treatment. The research staff built credibility and trust among the study participants. As initial skepticism towards the study faded, word about the project spread across the broader facility.

Growing enthusiasm towards the project became evident as several participants independently and organically created artwork inspired by the study, without prompting or facilitation from the research team or DOC staff. One participant created 2 EXIT-CJS posters, one depicting two hands in chains that are breaking, one hand labeled XR-B and the other XR-NTX. In sharing their artist statement, the participant explained: “I wanted the chains to be in the process of breaking, so that it’s clear these medications give you a chance that you have to be willing to take.”

Upon release from incarceration, participants will be eligible for 6 months of treatment as part of the study and will be linked to ongoing care thereafter. Achieving a continuum of care for study participants is important because people exiting jails and prisons are at heightened risk of treatment discontinuation, return to opioid use, and overdose. The EXIT-CJS trial will provide new data on long-acting injectable medications that may demonstrate the treatment’s effectiveness for justice-involved populations as it offers an extended window of protection during a person’s reentry journey.

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