Justice involvement patterns, overdose experiences, and naloxone knowledge among men and women in criminal justice diversion addiction treatment

Abstract

Background Persons in addiction treatment are likely to experience and/or witness drug overdoses following treatment and thus could benefit from overdose education and naloxone distribution (OEND) programs. Diverting individuals from the criminal justice system to addiction treatment represents one treatment engagement pathway, yet OEND needs among these individuals have not been fully described. Methods We characterized justice involvement patterns among 514 people who use opioids (PWUO) participating in a criminal justice diversion addiction treatment program during 2014–2016 using a gender-stratified latent class analysis. We described prevalence and correlates of naloxone knowledge using quasi-Poisson regression models with robust standard errors. Results Only 56% of participants correctly identified naloxone as an opioid overdose treatment despite that 68% had experienced an overdose and 79% had witnessed another person overdose. We identified two latent justice involvement classes: low involvement (20.3% of men, 46.5% of women), characterized by older age at first arrest, more past-year arrests, and less time incarcerated; and high involvement (79.7% of men, 53.5% of women), characterized by younger age at first arrest and more lifetime arrests and time incarcerated. Justice involvement was not associated with naloxone knowledge. Male participants who had personally overdosed more commonly identified naloxone as an overdose treatment after adjustment for age, race, education level, housing status, heroin use, and injection drug use (prevalence ratio [95% confidence interval]: men 1.5 [1.1–2.0]). Conclusions All PWUO in criminal justice diversion programs could benefit from OEND given the high propensity to experience and witness overdoses and low naloxone knowledge across justice involvement backgrounds and genders. Electronic supplementary material The online version of this article (10.1186/s12954-019-0317-3) contains supplementary material, which is available to authorized users.

A scoping review of factors that influence opioid overdose prevention for justice-involved populations

“…• Incarceration could represent a significant opportunity to provide evidence-based treatments, including MAT. Gicquelais, Mezuk, Foxman, Thomas, & Bohnert, 2019 [ 18 ] To obtain information from justice-involved individuals in a drug treatment program that can be used to inform OEND planning Survey 514 adults sampled from residential SUD treatment program, whose treatment was prompted by the CJS and had a history of heroin use or opioid misuse in Michigan • 56% of participants correctly identified naloxone as an opioid overdose treatment, although 68% had experienced an overdose and 79% had witnessed another person overdose. • Two latent justice involvement classes were identified (low and high), however, justice involvement was not associated with naloxone knowledge.…”

“…In a sample of adults with a history of OUD who had been court-referred to residential SUD treatment in Michigan, over two thirds of the sample had overdosed or witnessed an overdose, however, only 56% correctly identified naloxone as an overdose prevention strategy [ 18 ]. Level of prior justice involvement did not differentiate those with knowledge of naloxone, although males who had a history of overdose were more likely to identify naloxone as a prevention strategy.…”

“They’re not doing enough.”: women’s experiences with opioids and naloxone in Toronto

“…Variabilities in naloxone access and knowledge have the potential to impact its effectiveness [ 69 , 70 ]. Only 56% of participants in a recent large survey of formerly incarcerated men and women in addiction treatment in Michigan correctly identified naloxone as an opioid overdose antidote [ 71 ]. These variabilities by region, demographics, and through the naloxone use cascade, all highlight a need for further research into specific groups who use opioids, to determine how they acquire naloxone knowledge or perceive naloxone use.…”

“…Naloxone availability in Ontario and in Canada more broadly has evolved significantly in recent years, between the creation and expansion of take-home naloxone programs in major cities, and federal adjustments to dispensing requirements allowing access to the medication without a prescription as of June 2016 [ 67 , 68 ]. However, regional variabilities in naloxone uptake by pharmacies and local populations [ 69 , 70 ], along with American research indicating naloxone awareness, use, or carrying of a kit is not always commensurate with increased availability [ 71 ], point to a need to understand whether or how women in Ontario are learning about, accessing, and using naloxone. This is especially necessary in light of the 2017 Toronto Overdose Action Plan stressing the city’s need for expanded naloxone access [ 72 ], as well as international research, mostly involving men, pointing to issues or difficulties people may have surrounding its usage, such as strained peer relationships, precipitated opioid withdrawal, and a lack of overdose aftercare [ 73 – 76 ].…”

Opioid‐related overdose deaths among African Americans: Implications for research, practice and policy

“…African Americans are more likely to be criminalised for drug use [2–3,19] and therefore may be less likely to approach law enforcement officers or first responders to request naloxone [26]. Therefore, increasing the availability of naloxone through distribution when a person is released from jail or prison [62–64], coupled with targeting African American communities for naloxone education [65], could also reduce the increasing death rates among this group.…”