Extended-Release Buprenorphine Utilization in Justice Settings: Insights From Two JCOIN Studies

Friends Research Hub conducted two recent JCOIN 1.0 studies that offer complementary perspectives on how extended-release buprenorphine (XR-B) can be initiated and sustained across incarceration and reentry. These studies were conducted across several Maryland jails to help correctional systems understand both the feasibility of starting treatment in custody and the patient experience that shapes ongoing treatment.

The first study evaluated whether rapid, four-day sublingual buprenorphine (SL-B) induction could safely transition individuals to a weekly XR-B injection on day five. The investigators enrolled 65 adults with opioid use disorder who were nearing release and documented a high degree of feasibility. Most participants (81.5%) completed induction on schedule, demonstrating that a streamlined process is feasible even for individuals who are not opioid-tolerant. When including individuals who were delayed for logistical reasons (e.g., court dates, early release, COVID-related restrictions), successful transition to XR-B rose to 93.8% (Gordon et al., 2024).

The second study examined the experiences of 10 justice-involved individuals who received two different formulations of extended-release buprenorphine: Brixadi™ and Sublocade™. Due to a temporary interruption in the medication supply, participants receiving Brixadi were switched to Sublocade for one dose and then switched back. This created a rare opportunity for participants to directly compare the two formulations. Across interviews, 9 out of 10 participants reported more injection-site discomfort with Sublocade, describing greater pain, irritation, or persistent lumps following the monthly injection. Brixadi was consistently described as less painful, with fewer injection-site reactions (Blue et al., 2025). Experiences with cravings, withdrawal symptoms, and medication “wearing off” varied and did not show a clear advantage for either medication. Seven participants said they prefer Brixadi for future treatment (Blue et al., 2025).

Implications for Justice Settings

Together, these studies provide a fuller understanding of XR-B implementation in jail and during community re-entry. 

• Operational feasibility: Rapid SL-B to XR-B induction is safe, well-tolerated, and can be completed efficiently within jails.
• Patient acceptability: Individuals with experience with both medications strongly preferred Brixadi. However, it is important to note that this conclusion is drawn from a small sample and warrants further study in larger populations.
• Support for re-entry: Weekly and monthly XR-B options allow for a continuity of care during a period marked by high risk for overdose.

This combined evidence supports XR-buprenorphine as a practical and patient-centered MOUD option for justice settings, addressing both operational concerns and patient experience.