Individuals with criminal justice involvement experience elevated rates of Opioid Use
Disorder (OUD) and are at significantly higher risk of death from opioid overdose in the
first year following release from jail/prison. Medications for OUD (MOUD) are an
evidence-based approach to treating OUD and offer extensive benefits including lowering
rates of mortality, illicit opioid use, HIV transmission, violent crime, and arrest.
While many correctional settings have started to implement MOUD, there are significant
challenges to continuing medication/treatment while transitioning back to the community.
Intersectional stigma related to addiction and history of incarceration is associated
with greater difficulties with reintegration, increased isolation, and heightened
feelings of loneliness. Lack of social connectedness further serves as a risk factor for
decreased retention in treatment, discontinuation of MOUD, and a return to substance use.
Peer support is a key component of many evidence-based OUD recovery programs. When used
in conjunction with MOUD, it has the potential to improve perceived social support,
self-efficacy, and treatment engagement. However, access to live peer support has been
challenged by COVID restrictions, highlighting a critical need for digital health
platforms to deliver peer support. The Marigold Mobile Peer Support ("MPS") App is a
dedicated, secure, mobile application that employs structured, live peer moderation to
guide text-based conversations with groups of participants and behind-the-scenes natural
language processing (NLP) to automatically identify "red flag" content within peer chats.
While initial work demonstrates the utility of deploying the MPS App in outpatient
treatment settings for OUD, it has yet to be tested in correctional settings or among
justice-involved populations. The goal of the proposed application is to advance
evidence-based and scalable treatments for OUD, by decreasing loneliness and enhancing
perceived social support via novel application of an established mobile app among
individuals with a history of engaging in MOUD while in jail/prison. The study will be
accomplished through two primary aims: (1) develop an implementation manual to guide
delivery of the MPS App for those with a recent (past year) history of engaging in MOUD
while in jail/prison by conducting in-depth interviews with prospective app users and
other key stakeholders; and (2) conduct a randomized controlled trial to assess
feasibility, acceptability, and preliminary efficacy of the MPS App relative to enhanced
treatment-as-usual among individuals with a recent (past year) history of engaging in
MOUD while in jail/prison. Findings from this study will be used to develop a R01
application to conduct a fully-powered Hybrid Type 1 Effectiveness-Implementation study.