People leaving jail face a very high risk of overdose, especially in the first few weeks after release. Staying on medication for opioid use disorder (MOUD) can greatly reduce this risk, but many people stop treatment during this transition. This study is testing whether a program that offers rewards, called contingency management (CM), can help people stay on MOUD after they return to the community.

In this study, people who are taking MOUD in jail can choose to participate. While still incarcerated, they complete one visit where they may receive a small incentive, such as commissary credit or snacks, for enrolling in the CM program. After they leave jail, participants can earn gift cards when they attend their MOUD appointments and counseling sessions.

Participants may take part in the study for up to three months after release. During this time, they can earn up to $600 in incentives based on their treatment engagement. Researchers will also ask participants to complete a baseline survey and a survey at 3 months. We will also review medical records to confirm whether they continued their MOUD.

The researchers want to learn whether this adapted contingency management program is feasible, acceptable to participants, and helpful for supporting treatment engagement after release from jail. The findings will help determine whether this approach should be tested in a larger study to reduce overdose risk and improve health during the post-release period.

Inclusion Criteria:

• Be adults (age ≥18 years) currently incarcerated at Clatsop County Jail
• Be enrolled in the jail's MOUD program at the time of recruitment
• Plan to continue MOUD with Clatsop Behavioral Healthcare upon release
• Speak English and be able to provide informed consent

Exclusion Criteria

Exclusion Criteria:

• Are unable to provide informed consent due to cognitive impairment or acute psychiatric instability
• Are scheduled for transfer to a different facility or geographic location that prevents post-release participation