Opioid treatment and the criminal justice system
By Chloe Reichel
Opioid users referred for treatment by the criminal justice system were 10 times less likely to receive evidence-based treatments such as methadone than those referred by other sources.
The issue: Drug use and dependence are particularly common in populations involved with the criminal justice system. A 2017 report from the Bureau of Justice Statistics finds that between 2007 and 2009, approximately 58 percent of state prisoners depended on or abused drugs in the year prior to incarceration. In fact, many are in prison because of drug crimes, including possession.
Some entering the criminal justice system with drug dependencies will be referred to treatment. For opioid users, agonist therapies including methadone, buprenorphine, and naltrexone are evidence-based treatments for addiction. These medications activate opioid receptors in the brain, lessening symptoms of craving and withdrawal. But not all receive this treatment. A new study examines how often the criminal justice system refers adults to different types of drug-abuse treatments.
An academic study worth reading: “Only One in Twenty Justice-Referred Adults in Specialty Treatment for Opioid Use Receive Methadone or Buprenorphine,” published in Health Affairs, December 2017.
About the study: Researchers at the Johns Hopkins Bloomberg School of Public Health analyzed data from the 2014 Treatment Episode Data Set-Admissions (TEDS-A). This data set offers details on admissions to state-regulated treatment facilities nationwide. The researchers focused on adults entering treatment for opioid use disorder, analyzing just over 72,000 records. They looked at these records to determine who made the referral and whether clients were directed to agonist treatment. In particular the researchers focused on the relationship between referrals from the criminal justice system and agonist treatment. Sources of referrals within the criminal justice system include: prisons; state, federal, or local courts; parole or probation offices; diversionary programs; programs for individuals charged with driving under the influence (DUI) or driving while intoxicated (DWI); and other legal entities, including corrections agencies and youth services.
- Nearly one-quarter of the clients in the sample were referred to treatment by criminal justice sources.
- 41 percent of those referred by sources outside the criminal justice system received opioid agonist treatment compared with less than 5 percent of those referred by criminal justice sources.
- Adults involved with the criminal justice system were most likely to be referred for agonist treatment by a DUI or DWI program. People were least likely to receive opioid agonist treatment if they were referred by courts. Nearly 10 percent of those referred by DUI or DWI programs were recommended agonist treatment, compared with 3.4 percent of people referred by courts.
- The researchers suggest a number of factors might explain these discrepancies. They write that treatment facilities affiliated with the criminal justice system might avoid opioid agonist treatment because of ideological or operational concerns. They suggest corrections staff and judges might have stigma against agonist treatment, and that criminal justice-referred clients might also harbor similar biases.
- A 2014 study published in Addictive Behaviors, “Methadone Maintenance Treatment May Improve Completion Rates and Delay Opioid Relapse for Opioid Dependent Individuals Under Community Corrections Supervision,” finds that one-third of drug-treatment clients who received agonist therapy relapsed compared to 56 percent of clients who did not.
- A 2014 study published in European Addiction Research, “Impact of Methadone Maintenance Treatment on Women Offenders’ Post-Release Recidivism,” indicates that those who received agonist therapy had a 65 percent lower risk of recidivism than a control group that did not receive methadone.
- A 2010 study published in Addiction, “Meta-Analysis of Drug-Related Deaths Soon After Release from Prison,” finds an increased risk of drug-related death in the month following release from prison.
- A 2015 study published in Addiction Science and Clinical Practice, “Release from Incarceration, Relapse to Opioid Use, and the Potential for Buprenorphine Maintenance Treatment: A Qualitative Study of the Perceptions of Former Inmates with Opioid Use Disorder,” explores some of the stigma around agonist therapy, including fear of dependency and belief in willpower over the use of medication.
Last updated: December 18, 2017
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Citation: Krawczyk, Noa; Picher, Caroline E.; Feder, Kenneth A.; Saloner, Brendan. “Only One in Twenty Justice-Referred Adults in Specialty Treatment for Opioid Use Receive Methadone or Buprenorphine,” Health Affairs, December 2017, Vol. 36, No. 12. DOI: 10.1377/hlthaff.2017.0890.