Opioid Abuse and Criminal Justice Link Strong

Opioid Abuse and Criminal Justice Link Strong

More than half of all Americans who abuse prescription opioids, and nearly 80 percent of heroin users, have high levels of involvement in the criminal justice system, says the first national study of the association between opioid use and the criminal justice system.

The same individuals also suffer from "complicated health profiles" involving both physical and mental health conditions, the study said.

Combating the opioid epidemic will require expanded public health interventions that involve criminal justice systems, and new policies that will "reduce involvement in the criminal justice system among individuals with substance use disorders," the study says.
"Criminal justice involvement among people who use opioids was more common than we anticipated," said Tyler Winkelman, MD, MSc, of Hennepin Healthcare in Minneapolis, a co-author of the study. "There have been reports that jails and prisons are bearing the brunt of the opioid epidemic, but we didn't know nationally how many people who use opioids were involved in the criminal justice system," he told MedPage Today.

Disrupts or delays treatment

There are problems involved in the interaction with the criminal justice system, Winkelman said, because it often disrupts or delays treatment. Most people who are incarcerated don't get medication-assisted treatment (MAT). Instead they're forced to withdraw abruptly and completely in what is potentially the most painful way to stop taking opioids.

"It is paradoxical that correctional facilities are required by law to provide evidence-based healthcare for hypertension, heart disease, diabetes, asthma, HIV, and other health problems," commented George Woody, MD, of the Perelman School of Medicine at the University of Pennsylvania, who was not involved with the study, "but [not for] opioid use disorders, among the most common problems among persons in correctional facilities and other criminal justice settings..."

First to relate opioids and the justice system

The researchers say this may be the first study to "quantify the independent association between criminal justice system involvement and levels of opioid use." The conclusions derived from the 2015-2016 National Survey on Drug Use and Health, which surveyed Americans aged 18 to 65.

Of the 78,976 respondents:

  • 63.2% reported no opioid use
  • 31.3% reported prescription opioid use
  • 4.3% reported prescription opioid misuse
  • 0.8% reported prescription opioid use disorder
  • 0.4% reported heroin use

Compares to people who reported no opioid use, people who reported any level of opioid use were significantly more likely to:

  • Be white
  • Have low income
  • Report a chronic condition, disability, severe mental illness, or
  • Report co-occurring drug use
Involvement in the criminal justice system (excluding minor traffic violations) climbed along with the level of opioid use. A history of criminal justice involvement was associated with:
  • 15.9% of those who reported no opioid use
  • 22.4% of those who reported prescription opioid use
  • 33.2% of those who reported prescription opioid misuse
  • 51.7% of those who reported prescription opioid use disorder
  • 76.8% of those who reported heroin use
To sum up, physical and mental health conditions, co-occurring substance use, and involvement in the criminal justice system were higher among individuals with any level of opioid use compared with individuals who reported no opioid use, the study says.

Because of these findings, the authors say, policy makers,

"should carefully consider how changes to public health insurance programs and sentencing guidelines may aid or hinder a public health approach to the opioid epidemic. Future research should examine whether improved linkages between criminal justice, public health, and health care systems can reduce opioid-related morbidity and mortality and further explore the causal pathways involved in the association between opioid use and involvement in the criminal justice system."

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