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

NCJ Number
American Journal of Drug and Alcohol Abuse Volume: 47 Issue: 1 Dated: October 2021 Pages: 117-126
Noa Krawczyk ; Ramin Mojtabai; Elizabeth A. Stuart; Michael I. Fingerhood; Deborah Agus; B. Casey Lyons; Jonathan P. Weiner; Brendan Saloner
Date Published
October 2021

Focusing on a Maryland state-wide sample of justice-involved individuals, this study explored predictors of opioid use disorder (OUD) treatment use and the relationship between referral source to treatment, treatment with opioid agonists, and risk of a fatal opioid overdose.


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. In the current study, 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 use and overdose risk among justice-involved adults who received OUD treatment. The study found that of 43,842 justice-involved adults (80 percent male), nearly 20 percent used OUD treatment. Of these, 58 percent 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 the odds of fatal overdose by 60 percent. The study concluded that 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. (publisher abstract modified)