ABSTRACT
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.
