SAFE GC Coalition: Opioid Use and the Criminal Justice System

A recent study published by the Journal of the American Medical Association (JAMA) revealed that individuals addicted to prescription opioids or heroin also have complicated health profiles and high levels of involvement in the criminal justice system. The study provides the first nationwide estimate for the number of people using opioids who end up in the American criminal justice system.

According to JAMA, 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 individuals with substance use disorders.

The connection between the criminal justice system and substance abuse is well-known. According to the National Institute on Drug Abuse (NIDA), about 65 percent of people who are incarcerated are known to have a substance use disorder and yet there is little national data tracking the co-occurrence of the criminal justice system and the ongoing opioid epidemic.

To obtain the needed national picture, Clinician-investigator and lead author of the study, Dr. Tyler Winkleman, and his colleagues analyzed data from 78,976 respondents to the annual National Survey on Drug Use and Health which collects information on substance use by respondents, as well as information on their socioeconomic status, education and health. The study reveals that only 3 percent of the general population (with no opioid use) reported being recently arrested or on parole or probation — the study's measure of involvement with the criminal justice system. Any amount of prescription opioid use was correlated with greater involvement. Among people with prescription opioid use disorder, nearly 20 percent had criminal justice involvement. For heroin users, it was 40 percent.

According to Winkleman. people who use opioids, including heroin, were up to 13 times more likely to be involved in the criminal justice system. The study also showed that most people with opioid use disorder had other mental illnesses and were also more likely to have certain chronic health conditions, such as asthma and chronic obstructive pulmonary disease.

The argument for the need to engage and involve the criminal justice system in dealing with the opioid epidemic, including reducing overdose deaths has therefore been put forth. Researchers maintain most jails and prisons don't offer medication-assisted treatment using the three FDA-approved drugs for the treating opioid use disorder: buprenorphine, methadone and naltrexone. Treatment with medication is the most effective option for people addicted to opioids.

The study discusses additional research regarding incarceration and opioid relapse. Incarcerating people with addiction without offering treatment makes them more vulnerable to dying from an overdose when they are released. Those who were already on treatment have to stop abruptly. And those who weren't on treatment when arrested have to detox. Over time, incarcerated persons tolerance reduces. If they relapse when they're released that relapse is extremely dangerous, because you don't have tolerance, and you need a minuscule amount of fentanyl to cause a fatality as most of the heroin and illicit opioid supply today is contaminated with fentanyl and other related synthetic opioids, which are more powerful and deadly.

Winkelman urges alternatives to incarceration for people with addictions urging a response that will ideally prevent people from entering the criminal justice system in the first place. Given the fact that there are ways of diverting people with mental health crises to acute mental health care and there are ways of diverting juveniles from juvenile detention to some form of community corrections, where they remain in the community, similar efforts should be taken to divert people with opioid use disorders to treatment facilities. Winkleman also feels that correctional facilities should also adhere to this logic. Winkelman goes on to reference a successful community based service program in Seattle and a correctional facility based program that treats addicted inmates medically in Rhode Island.

Results of Winkleman’s study reveal a critical need for jails and prisons to provide effective treatment to inmates, maintaining the criminal justice system needs to be much more equipped to reduce the risks in the population that they encounter by ensuring that incarcerated individuals have access to evidence-based substance use treatment.

To read the full JAMA study, please visit https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2687053.

The SAFE Glen Cove Coalition is conducting an opioid prevention awareness campaign entitled "Keeping Glen Cove SAFE" to educate and update the community regarding opioid use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.