**Background/Objectives:** Few studies have assessed HRQoL among individuals with OUD who are involved with the justice-system, let alone over the period directly surrounding release from incarceration. The purpose of this study is to conduct a comprehensive secondary analysis of HRQoL data, to test differences in, and evaluated determinants of HRQoL (EQ-5D) domains (mobility, pain/discomfort, anxiety/depression), as well as the preference/utility score, during the period just prior to and 3 months immediately after release.
**Methods:** Secondary longitudinal data were collected from a clinical trial where participants were randomized 1:1 to pre-release XR-NTX + referral to community XR-NTX, vs. referral only (Woody et al., 2021). Data were collected from a prison and publicly funded substance abuse disorder (SUD) treatment center in a Northeastern U.S. state for 6-months post-release from incarceration. We conducted secondary, multivariable, longitudinal analyses of EQ-5D domains (mobility, pain/discomfort, anxiety/depression), and the overall preference/utility score. Longitudinal HRQoL data was subset to timepoints immediately before release (baseline) and immediately post-release (3-month), resulting in a study sample of n=86. Multiple imputation by chained equations was conducted to handle missing 3-month data in the dependent variables and covariates, ad hoc. Ordinal logistic regression was used to analyze domain scores and OLS was used to analyze the utility score, controlling for several covariates (i.e. addiction severity index (ASI) composite score, intravenous drug use history etc.).
**Results:** Greater severity in the psychiatric composite score was associated with substantially lower HRQoL, across all measures, following release from incarceration. Greater severity in the medical composite score was associated with lower pain/discomfort-related HRQoL. Release from incarceration, by itself, was not associated with increased HRQoL at 3-months.
**Conclusions:** Our findings highlight the importance of ensuring individuals with OUD are linked not only to MOUD, but also treatment for their comorbid conditions upon release from incarceration.