The Non-Medical Use of Prescription Drugs Among Criminal Justice-Involved Women: the Role of Trauma and Inter-Personal Violence

Background and Purpose: A history of inter-personal violence (IPV) and trauma has been consistently linked with the non-medical use of prescription drugs (NMUPD). Women involved in the criminal justice system report high rates of IPV, though few studies have specifically investigated NMUPD in this vulnerable population. This study had two primary aims. First, to describe the prevalence and correlates of NMUPD among victimized women involved in the criminal justice system. Second, previous studies have shown that NMUPD is often motivated by self-treatment. We hypothesized that criminal justice-involved women who report recent NMUPD would have higher rates of victimization and post-traumatic stress disorder (PTSD) relative to women in the criminal justice system who did not report recent NMUPD.

Methods: The sample consisted of 406 women (41.6% African American; 50.5% White; 7.6% Other races) on probation and/or parole in the largest metropolitan city of a Midwestern state. Recruitment methods included: face-to-face recruitment at all of the probation and parole offices within the county; direct mailings to women on probation and parole; print, TV, and web-based advertisements; fliers posted in a variety of public locations, community based organizations, government agencies, and health care facilities. All interviews were administered face-to-face by trained female staff using audio computer-assisted interviewing. IPV was measured by items from the Victimization Survey of the National Crime Victimization Survey, PTSD was measured by the Posttraumatic Stress Diagnostic Scale (PDS), the Brief Symptom Inventory (BSI) was used to measure psychiatric distress, and recent NMUPD was conceptualized as use of prescription opioids, sedatives, benzodiazepines or barbiturates within in the past year. Bivariate and adjusted comparisons were conducted using chi-square tests and logistic regression for categorical variables and t tests and multiple regression for continuous variables. Multiple logistic regression was used to identify correlates of NMUPD. 

Results: Past year NMUPD was reported by 26.8% (n = 109) of the overall sample. With regard to demographics, women who reported NMUPD tended to be younger and were more likely to be White. Women who endorsed NMUPD reported higher rates of psychiatric problems on all nine symptom domains of the BSI. Women who reported NMUPD were also more likely participate in drug treatment and utilize medications for detoxification or opioid replacement therapy relative to women who did not engage in past-year NMUPD. Though women who reported NMUPD were just as likely as those who did not report NMUPD to experience a traumatic event in their lifetime, those who endorsed NMUPD were more likely to experience persistent problems and meet diagnostic criteria as a result. In the multiple logistic regression model identifying correlates of NMUPD, younger age, White race, chronic pain, psychological IPV and a diagnosis of PTSD were significant. In particular, criminal justice-involved women who did not meet criteria for PTSD were 40% less likely to engage in past-year NMUPD.

Conclusions and Implications: Rates of NMUPD are high among women involved in the criminal justice system and the successful prevention and treatment of NMUPD should integrate evidence-based approaches to trauma and IPV.