Characteristics and Psychosocial Needs of Opiate Addicted Individuals Enrolled in an Ohio Drug Court Pilot Program

Background:  Over the past fifteen years, the use of heroin and opioid pain relievers (OPRs) in the U.S. has significantly increased.  Prescription pain relievers are the second most commonly abused drug in this country, only behind marijuana. Escalations in opioid use, morbidity, and mortality parallel increases in OPR prescribing rates which quadrupled between 1999 and 2010. 70-80 % of heroin users who started heroin use after 1980 reportedly used OPRs nonmedically before initiating heroin. The purpose of this study is to explore the characteristics and psychosocial needs of participants in Medication Assisted Treatment Drug Courts (MAT). 

Methods: Data used derived from a university-based study of the Ohio Addiction Treatment Pilot Program (ATPP) addressing problems of recurring substance abuse and recidivism in non-violent, opiate/opioid use disorder (moderate and severe) adult offenders.   The offenders were provided intervention, access to a continuum of alcohol and drug treatment and rehabilitation services and close judicial supervision.  The ATPP is a collaborative effort among Ohio Courts, Ohio Department of Mental Health and Addiction Services and local Alcohol and Drug Addiction Service Boards.  Data from nine ATTP drug courts throughout Ohio were used.

SAMPLE:   The sample size was 404 participants at intake, 217 at six-month follow up. Sources for data collection include: The Ohio Risk Assessment System (ORAS) - a screening tool used to predict future recidivism risk and guide treatment planning; the Government Performance Results Act Survey (GPRA) - a self-report survey that measures client’s current substance use, violence exposure, criminal justice status, level of education, employment status, housing self-sufficiency, access to medical services and high-risk behaviors; and the Lifetime Exposure to Violence Scale - measures violence exposure throughout one’s life. 

 Results: The overwhelming majority of participants were white (95%), under 35 years old (81%), unemployed (74%), and all were diagnosed with an opioid disorder. 80% had a high school education or less. Screenings for co-occurring mental and substance disorders indicated 62% met criteria for a co-occurring disorder.  Depression (38%) and anxiety (54%) were the most commonly reported mental health symptoms.  46% of the sample reported engaging in sexual activity in the past 30 days, two-thirds of whom reported having unprotected sexual contacts during that time period. 68% of individuals reporting recent IV drug use reported having unprotected sexual contacts in the past 30 days.  Approximately 65% of individuals reported being either a victim or witness to violence.  Logistic regression revealed the odds for recidivism into the criminal justice system were 2.9 times higher for individuals who had been exposed to violence in their lifetime.

Conclusions: While the mortality and morbidity of individuals with opioid addiction continue, it is critical we develop  meaningful approaches of prevention and treatment. Significant areas of clinical concern identified in this sample include high rates of co-occurring disorders, violence exposure, equipment sharing and unprotected sexual activity and concomitant HIV risk.  Our data suggest the importance of providing drug court participants with specialized services including mental health services that emphasize trauma informed care, reproductive health counseling, and access to syringe exchange programs.