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A new study published in the Journal of Substance Use and Misuse looked at opioid agonist treatment recipients within criminal justice-involved populations.

“Treating individuals who use opioids with medication and counseling support is the gold standard for addressing opioid use disorders, yet the majority of those who need this treatment do not receive it,” study author Wendy P. Guastaferro told us. “For those individuals involved with the criminal legal system, the chances of receiving this life saving treatment is even less.” 

Guastaferro is the Director of the School of Criminology & Criminal Justice at the Florida Atlantic University College of Social Work & Criminal Justice.

As reported in Vera, of the over two million people in jail in the US, one in five people are in jails are in there due to drug-related offenses. According to statistics from National Inmate Surveys from the years 2007 to 2009, over sixty per cent of people in jails in the US were suffering from a substance use disorder.

Only one in 20 adults in the justice system who could benefit from treatment actually receive it. The goal of the study was to understand differences between people involved with the criminal legal system who received opioid agonist treatment (OAT) compared to those who did not.

“We knew from previous studies that people under the supervision of the criminal legal system were less likely to access OAT,” Guastaferro told us. “Our study sought to dig a little deeper into why this is the case.”  

The opioid epidemic in the US has impacted thousands of individuals, families, and communities. There is a strong connection between substance use and misuse and criminal behavior, often due to individuals are engaging in criminal behavior to get money or goods to sell to acquire drugs. 

“The justice system cannot arrest or imprison our way through this,” Guastaferro told us. “We are obligated to intervene in ways that are effective to improve the health and safety of individuals and our communities.”  

Researchers used a nationally representative database of treatment admissions to examine differences in demographics, substance use severity, and access to treatment for individuals referred to OAT by the criminal justice system. They identified factors that made one more or less likely to receive OAT to account for treatment disparities within a criminal justice population.

“We found that fewer than six per cent of criminal justice cases received OAT as part of the treatment plan,” Guastaferro told us. “Those with daily substance use, comorbid psychiatric problems, prior treatment females, Latinos, and those who were older and those who were living independently were more likely to receive this treatment, as were those living in the Northeast and with government health insurance.”

A few findings speak to the challenges of addressing this problem. For example, the majority of the sample were poly-drug users who reported heroin as a drug of choice and had previously received substance use treatment and there is a dire need for more certified opioid treatment programs—nearly half of all US counties do not have a physician approved to prescribe or dispense buprenorphine, a medication for opioid use disorder. 

Importantly, although largely framed as a problem that affects White individuals, opioid use has had significant and growing impact on communities of color as well. Between 2010 and 2018, opioid overdose deaths increased 355 percent among Black individuals and 218 percent for Hispanic individuals.

“There are several barriers to providing treatments that work,” Guastaferro told us. “The lack of medical and counseling providers across the country, cost, the general orientation toward punishing people for having an addiction, and the stigma associated with substance use and opioid use disorders in particular, are key challenges to effectively addressing the opioid epidemic.”