Health, Polysubstance Use, and Criminal Justice Involvement Among Adults With Varying Levels of Opioid Use

Abstract

Importance Health profiles and patterns of involvement in the criminal justice system among people with various levels of opioid use are poorly defined. Data are needed to inform a public health approach to the opioid epidemic. Objective To examine the association between various levels of opioid use in the past year and physical and mental health, co-occurring substance use, and involvement in the criminal justice system. Design, Setting, and Participants This retrospective, cross-sectional analysis used the 2015-2016 National Survey on Drug Use and Health to assess the independent association of intensity of opioid use with health, co-occurring substance use, and involvement in the criminal justice system among US adults aged 18 to 64 years using multivariable logistic regression. Exposures No opioid use vs prescription opioid use, misuse, or use disorder or heroin use. Main Outcomes and Measures Self-reported physical and mental health, disability, co-occurring substance use, and past year and lifetime involvement in the criminal justice system. Results The sample consisted of 78 976 respondents (42 495 women and 36 481 men), representative of 196 280 447 US adults. In the weighted sample, 124 026 842 adults reported no opioid use in the past year (63.2%; 95% CI, 62.6%-63.7%), 61 462 897 reported prescription opioid use in the past year (31.3%; 95% CI, 30.8%-31.8%), 8 439 889 reported prescription opioid misuse in the past year (4.3%; 95% CI, 4.1%-4.5%), 1 475 433 reported prescription opioid use disorder in the past year (0.8%; 95% CI, 0.7%-0.8%), and 875 386 reported heroin use in the past year (0.4%; 95% CI, 0.4%-0.5%). Individuals who reported any level of opioid use were significantly more likely than individuals who reported no opioid use to be white, have a low income, and report a chronic condition, disability, severe mental illness, or co-occurring drug use. History of involvement in the criminal justice system increased as intensity of opioid use increased (no use, 15.9% [19 562 158 of 123 319 911]; 95% CI, 15.4%-16.4%; prescription opioid use, 22.4% [13 712 162 of 61 204 541]; 95% CI, 21.7%-23.1%; prescription opioid misuse, 33.2% [2 793 391 of 8 410 638]; 95% CI, 30.9%-35.6%; prescription opioid use disorder, 51.7% [762 189 of 1 473 552]; 95% CI, 45.4%-58.0%; and heroin use, 76.8% [668 453 of 870 250]; 95% CI, 70.6%-82.1%). In adjusted models, any level of opioid use was associated with involvement in the criminal justice system in the past year compared with no opioid use. Conclusions and Relevance Individuals who use opioids have complicated health profiles and high levels of involvement in the criminal justice system. Combating the opioid epidemic will require public health interventions that involve criminal justice systems, as well as policies that reduce involvement in the criminal justice system among indi...

Evaluating the implementation of a prisoner re-entry initiative for individuals with opioid use and mental health disorders: Application of the consolidated framework for implementation research in a cross-system initiative

“…showed that criminal justice involvement increases as intensity of opioid use increases (Winkelman, Chang, & Binswanger, 2018). Additionally, about half of those with higher intensities of opioid usage (i.e., prescription opioid misuse, prescription opioid use disorder, or heroin use) also have co-occurring mental health issues (Winkelman et al, 2018).…”

“…showed that criminal justice involvement increases as intensity of opioid use increases (Winkelman, Chang, & Binswanger, 2018). Additionally, about half of those with higher intensities of opioid usage (i.e., prescription opioid misuse, prescription opioid use disorder, or heroin use) also have co-occurring mental health issues (Winkelman et al, 2018). People who have co-occurring disorders and are also incarcerated present a unique set of needs for accessing appropriate treatment and for successful reentry to the community (Chandler, Peters, Field, & Juliano-Bult, 2004).…”

A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017-2018 United States national survey

“…Sociodemographic factors have generally been identi ed as a de nitive risk factors in opioid misuse, and overdose death. [8,9,17,47,48] In the presence of biopsychosocial factors and other substance abuse we found that sociodemographic characteristics were no longer signi cant predictors but served as controls for our comprehensive opioid misuse model. Our model further revealed that socioecological and health factors are signi cant predictors.…”

“…Individuals with criminality or involvement with the legal system had a prevalence of 22.4% for prescription opioid use, 33.2% for prescription opioid misuse, 51.7% for prescription opioid use disorder, and 76.8% for heroin use. [17] Similarly, Pierce et al [18] found that, when adjusting for cocaine use, sex/gender, age, and birth cohort, individuals testing positive for opioid use had higher rates of criminality. Sexual minorities, such as those identifying as gay/lesbian or bisexual, have also been situationally reported to be at risk of opioid misuse.…”

Health Insurance Gains After Implementation of the Affordable Care Act Among Individuals Recently on Probation: USA, 2008–2016

“…1 People involved in the correctional system are more likely to have a chronic condition, substance use disorders, or mental illness and are at higher risk of being uninsured when compared with the general population. [2][3][4][5] In the first year after implementation of the Affordable Care Act's (ACA) key provisions, health insurance coverage increased for individuals with involvement in the criminal justice system. 2,6 Whether the ACA continued to improve coverage beyond its first year of implementation among this population is unknown.…”