Background: Not attending to local political climate negatively impacts the implementation and sustainability of evidence-informed models of health service. Policy codesign aims to align policy, systems, and community from the ‘ground up’, with structured information gathering, synthesis and creative design methods that incorporate relevant scientific evidence.<br/>Aims and objectives: This paper provides an example of policy codesign to develop a jail-based re-entry programme for adults with opioid use disorder in a rural county in the US.<br/>Methods: The design process adapted Theory U, a systems planning framework to include a rapid evidence review. The process included five sessions from July-September 2020. Mixed methods were used to collect data from the design team (n=5), community at large (n=10), and potential consumers (n=14). Qualitative and descriptive analyses assessed satisfaction with the design process, and the acceptability and perceived feasibility of programme implementation.<br/>Findings: Satisfaction with the design process was high among design team members. Acceptability and perceived feasibility of the designed programme were ‘very high’ across all respondents. The community implemented the designed programme, which aligned with the extant evidence base, although design team members did not explicitly acknowledge research as a source of design. This suggests that the process achieved creative control, and qualitative findings support the teams’ sense of shared ownership.<br/>Discussion and conclusions: Policy codesign is a promising strategy for integrating the evidence base with community creativity in policy and systems-level planning. Further research is needed to understand which elements optimised design members’ absorption of the evidence base, shared sense making, and creative control.<br/><br/>Key messages<br/>Policy codesign aims to align policy, systems, and community from the ‘ground up’.<br/>Policy codesign was used to develop a jail-based programme for people with substance use disorder.<br/>The designed jail-based re-entry programme was rated as highly acceptable and feasible.<br/>The programme was consistent with evidence-based approaches and was successfully implemented.

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