Opioid agonist treatment is highly protective against overdose death among a U.S. statewide population of justice-involved adults

ABSTRACT

Background: Persons with justice-involvement have high rates of opioid use disorder (OUD) and overdose and are a critical target of policy initiatives to improve access to evidence-based medications for OUD. However, less is known about what characteristics of justice-involved persons make them more or less likely to receive evidence-based care.

Objectives: Focusing on a Maryland state-wide sample of justice-involved individuals, this study explores predictors of OUD treatment utilization and the relationship between referral source to treatment, treatment with opioid agonists, and risk of a fatal opioid overdose.

Methods: Records were obtained for persons with arrests, incarcerations, and community supervision cases related to property/drug crimes in Maryland in 2015–2016 (N = 43,842). Individuals were matched to records in three state databases: admissions to specialty substance use disorder treatment, buprenorphine prescriptions for office-based OUD treatment, and opioid overdose death records. Multivariate logistic regression was used to identify correlates of opioid agonist treatment utilization and overdose risk among justice-involved adults who received OUD treatment.

Results: Of 43,842 justice-involved adults (80% male), nearly 20% utilized OUD treatment. Of these, 58% received agonist medications. Those with polysubstance use diagnoses or referred to treatment directly by criminal justice sources were least likely to receive medications. Agonist medications reduced odds of fatal overdose by 60%.

Conclusions: Opioid agonist treatment was highly protective against overdose among justice-involved individuals receiving treatment in the community, but many still lacked access to this type of care. Policies and interventions to promote the expansion of opioid agonist treatment in community settings that serve justice-involved persons are critical.

KEYWORDS:

• Overdose
• criminal justice
• opioid use disorder
• treatment
• opioid agonist
• data linkage

Acknowledgements

The study sponsors had no role in determining study design; data collection, analysis, or interpretation; writing the report; or the decision to submit the report for publication. The points of view or opinions in this article are those of the authors and do not necessarily represent the official position, policies, or views of the U.S. Department of Justice, the Maryland Department of Health, the Maryland Department of Public Safety and Correctional Services, or its constituent agencies, or any of the State of Maryland agencies who made their data available for this study.

Authors would like to additionally thank members of the entire PRECOG team for their intellectual contributions and review of this work, including Kristin E. Schneider, Matthew D. Eisenberg, Tom M. Richards, Lindsey Ferris, and Klaus W. Lemke. We also would like to thank the Maryland Office of the Chief Medical Examiner and the Department of Public Safety and Correctional Services for providing data for this study.

Supplementary material

The supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This project was supported by [Grant No. 2015-PM-BX-K002] awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Department of Justice’s Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice. This research was also supported by the National Institute on Drug Abuse [F31DA047021, NK supported].