FRI is pleased to announce that Drs. Thomas R. Blue (MPI) and Michael S. Gordon (MPI) will continue their HEAL JCOIN 1 work as they have received a 5-year UM1 grant from the National Institute on Drug Abuse, the Justice Community Overdose Innovation Network (JCOIN) – Phase II entitled, “A patient preference trial of sublingual versus extended-release buprenorphine telemedicine and pharmacy linkage for individuals re-entering the community from jail.” The interdisciplinary team includes co-investigators, Dr. Frank, Vocci (FRI), Dr. Lauren Brinkley Rubenstein (Duke University, Department of Population Health Sciences), Drs. Eric Weintraub and Annebelle Belcher, (University of Maryland, School of Medicine); and Dr. Bethany Dipaula (University of Maryland, School of Pharmacy). This study is a patient preference trial (PPT) of extended-release buprenorphine (XR-B) vs. sublingual buprenorphine (SL-B) in 8 rural jails in Maryland. Adults with OUD soon-to-be-released from jail will be recruited and will choose to receive XR-B or SL-B treatment in jail via telemedicine followed by 6-months of post-release XR-B/SL-B treatment via telemedicine and medication administration at community pharmacies (N=500). Individuals receiving XR-B will have their community injections administered by a pharmacist, allowing the telemedicine intervention to be fully remote and equivalent to that of the SL-B group which will have their prescriptions filled at a local pharmacy. In addition, to understand implementation of telemedicine, XR-B, and SL-B in jails and continued at community pharmacies, the consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) frameworks will be utilized. Aim 1. Compare the effectiveness of XR-B vs. SL-B in terms of retention in buprenorphine treatment. Aim 2. Document factors relevant to implementation and sustainability of the telemedicine buprenorphine intervention in jails and pharmacy settings. Guided by CFIR and RE-AIM we will gauge 1) how to optimize key intervention components (e.g., dose induction, telemedicine procedures, medication preferences, continuity of care, inner and outer context factors, stigma, pharmacy procedures, improvement of the cascade of care for OUD) and 2) the RE-AIM of key implementation factors. To achieve this aim, we will conduct interviews with stakeholders (n = 80). This study will be innovative for two reasons: 1) it would be the first large scale PPT of XR-B/SL-B using telemedicine among individuals leaving jail; and 2) it would be the first study continuing XR-B injections with a re-entry population at pharmacies. This study will be highly significant because most individuals with OUD do not receive treatment while in jail, thereby substantially raising their likelihood of relapse to drug use, overdose death, and re-incarceration when they are released. A telemedicine program may improve the continuity of care between incarceration and re-entry which is the period in which individuals with an OUD are most vulnerable. Finally, understanding how to expand acceptance of MOUDs in jails using telemedicine and pharmacy administration of XR-B, has far-reaching implications for expanding treatment access.