Background: The opioid epidemic is a public health crisis affecting 10.3 million individuals in the U.S. People with co-occurring opioid use and mental health disorders (COD) involved in the criminal legal system are one of the hardest hit populations. There is a 12-fold increased risk of overdose within 2 weeks of release from incarceration. Re-entry services are a critical point to prevent overdose and improve the health and wellness of people with COD. However, less is known about factors that predict engagement during this critical time.

Methods: 173 individuals with COD that were offered up to 3 months of in-reach services and 12 months of multi-component, community-based integrated COD treatment that offered in-reach and post-release services. We computed a multivariate regression model to examine predictors of engagement.

Results: The mean length of stay was 204 days (range: 2-365). The regression model explained 28% (adjusted R² = .28; p < .004) of the variance in outcome of post-release days in treatment. The number of in-reach days of engagement (Mean = 56; β =.39, p<.001), and receiving Medication for Opioid Use Disorder (MOUD) (β =.36, p<.002) were significantly associated with longer lengths of stay when controlling for race, age, length of criminal justice involvement, and polysubstance use.

Conclusions: Increased in-reach services in conjunction with MOUD is an effective approach to boost engagement among re-entry populations with COD. Re-entry programs should consider how to increase lengths of in-reach engagement and identify client needs in advance of release to ensure a smooth transition into the community post-incarceration.