Background: Despite a growing body of empirical support for the effectiveness of extended-release naltrexone (XR-NTX) to reduce opioid relapse among people with opioid use disorder (OUD) transitioning from a correctional facility to the community, continuity of care following release remains challenging. This paper describes a research-based adaptation of a state’s standard of care XR-NTX protocol using the ADAPT-ITT framework for delivery in a non-traditional, non-treatment, community criminal justice setting (P&P office), as well as the expansion of services by a local Federally Qualified Health Center (FQHC) provider who would, for the first time, be going to the jail and P&P office to provide XR-NTX and related treatment. Method: The present study focuses on the first seven phases (Assessment through Training) of the ADAPT-ITT framework in the adaptation of the Department of Corrections (DOC) protocol in preparation for a pilot trial for induction in a rural jail and during the transition to a rural community. Expert clinical review and focus groups with key stakeholders in criminal justice supervision and the local providers in the FQHC informed the needed adaptations to the existing XR-NTX protocol for initiation at the jail and ongoing administrations in the community. Results: Findings from stakeholder focus groups, study team review, topical expert review, and a theater test suggested that there were critical adaptations needed in both content and context at the patient and clinic level. Conclusion: Health and justice officials should consider the need to tailor and adapt evidence-based approaches for real-world locations that high-risk, justice-involved individuals visit in order to reduce barriers and increase access to critically needed treatment for OUD.

Original languageEnglish
Article number4
JournalHealth and Justice
Issue number1
StatePublished - Dec 2021

Bibliographical note

Funding Information:
The current study builds on the empirical evidence for positive outcomes associated with XR-NTX for re-entering offenders, but expands the work to consider an innovative community model for ongoing treatment following jail release. In March 2015, state legislators passed Senate Bill 192 (SB192), a comprehensive drug policy that increased funding for MOUD (specifically XR-NTX) in Kentucky prisons and jails (Dantzler, ). The state Department of Corrections (DOC) Division of Addiction Services worked closely with a national pharmaceutical company and correctional health care officials to develop a clinical protocol for screening and administration of XR-NTX. Eligibility requirements included: an OUD diagnosis, within 60 days of anticipated release, a negative urine drug screen before a 3-day oral 50 mg/day naltrexone challenge, and not being pregnant. The DOC protocol included two XR-NTX administrations 1 month apart during incarceration with a referral to a community case worker (social service clinician) for coordination of and linkage to continued XR-NTX treatment and recovery services following release. The DOC protocol was, however, limited to offenders who received treatment in state Substance Abuse Programs (SAP), which are modified therapeutic communities mostly centralized in state prisons. Kentucky has 76 jails across 120 counties that house nearly 24,500 inmates daily (Kentucky DOC, ); only 22 of these jails (29%) have SAP programs with about 1600 treatment slots annually. Thus, there was a significant need to adapt the DOC protocol for XR-NTX administration to increase access to the medication in a rural jail setting and to reduce barriers to continued XR-NTX treatment upon community re-entry. The research-based adaptation, supported by a federal research grant, is the focus of this paper.

Funding Information:
The authors would like to recognize the support and contribution of the leadership of the Kentucky Department of Corrections as a partner on this project. We would also like to acknowledge the important partnership with the Little Flower Clinic as the FQHC partner. Without their significant contributions, this project would not be possible. We also acknowledge the contribution of Dr. Joshua Lee as the study consultant for his important feedback during study protocol development.

Publisher Copyright:
© 2021, The Author(s).


  • Community supervision
  • OUD
  • Rural offenders
  • XR-NTX

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Law


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