Criminal Charges Prior to and After Enrollment in Opioid Agonist Treatment: A Comparison of Methadone Maintenance and Office-based Buprenorphine

ABSTRACT

Background: Entry into methadone maintenance is associated with a reduction in criminal activity; less is known about the effects of office-based buprenorphine. Objective: To compare criminal charges before and after enrollment in methadone maintenance or office-based buprenorphine. Methods: Subjects were opioid-dependent adults who initiated either methadone maintenance (n = 252) or office-based buprenorphine (n = 252) between 2003 and 2007. Medical records were reviewed to gather demographic data and a state-maintained web-based database to collect data on criminal charges. Overall charges and drug charges in the 2 years prior to and after treatment enrollment were compared. Multivariable analysis was used to examine risk factors for charges after treatment enrollment. Results: In the 2 years after enrolling in treatment, subjects receiving methadone had a significant decline in the proportion of subjects with any charges (49.6% vs. 32.5%, p < .001) or drug charges (25.0% vs. 17.5%, p = .015), as well as the mean number of cases (0.97 vs. 0.63, p = .002) and drug cases (0.38 vs. 0.23, p = .008), while those who initiated buprenorphine did not have significant changes in any of these measures. On multivariable analysis, the strongest predictor of criminal charges in the 2 years after treatment enrollment was prior charges (adjusted odds ratio 3.35, 95% confidence interval, 2.24–5.01). Conclusions: Enrollment in office-based buprenorphine treatment did not appear to have the same beneficial effect on subsequent criminal charges as methadone maintenance. If this observation is replicated in other settings, it may have implications for matching individuals to these treatment options.

KEYWORDS:

• Crime
• buprenorphine
• methadone
• opioid-related disorders
• opioid agonist treatment

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

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Notes on contributors

Darius A. Rastegar

Darius A. Rastegar, MD, is an Associate Professor of Medicine in the Department of Medicine at Johns Hopkins School of Medicine. His clinic and research interests focus on the treatment substance use disorders in the primary care setting and inpatient treatment of substance withdrawal.

Sarah Sharfstein Kawasaki

Sarah Sharfstein Kawasaki, MD, is medical director at Health Care For the Homeless in Baltimore, Maryland. She is a primary care internist with a focus on substance use disorder, HIV and Hepatitis C treatment.

Van L. King

Van L. King, MD, is an Associate Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine in Baltimore, Maryland. He has a long-standing clinical and research interest in the study and treatment of severe substance use disorder and co-occurring psychiatric conditions and in the development of cost-effective, integrated, and evidence-based behavioral, medication, andpsychotherapeutic treatments to promote full recovery.

Elizabeth E. Harris

Elizabeth E. Harris, MD, is an assistant professor of Internal Medicine at Albert Einstein College of Medicine, Montefiore Medical Center. She provides direct patient care and teaches medical students and residents.

Robert K. Brooner

Robert K. Brooner, PhD, is Professor of Medical Psychology and Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Brooner's research and clinical efforts focus on improving the treatment scope and testing adaptive service approaches for patients suffering from substance use disorder.