Opioid Use Among Emerging Adults Previously Incarcerated for Serious Violent Juvenile Offenses

BACKGROUND AND PURPOSE: Media coverage over the past few years has highlighted the devastating effects of the opioid epidemic. The United States consumes over 80% of the world’s opioid pain relievers, even though our total population makes up less than 5% of the world’s population (Krans & Patrick, 2016). Emerging adults 18-24 have the highest rates of opioid consumption (SAMHSA, 2017). Opioid misuse contributes to the spread of human immunodeficiency virus and hepatitis C (Zibbell et al., 2017). Deaths attributed to this crisis have outnumbered deaths due to motor vehicle crashes (HHS, 2013). Despite the magnitude of the problem, the literature regarding opioid misuse among incarcerated youth is sparse (see Hall et al., 2010 for an exception).

Youth involved in the juvenile justice system, particularly those who have been incarcerated, may be at increased risk for opioid use during emerging adulthood compared to youth in the general population. Studies have found that incarcerated youth abuse substances at a higher rate than youth in the general population (Howard & Jenson, 1999; Howard, Balster, Cottler, Wu, & Vaughn, 2008).

Youth who have been incarcerated also have high rates of meeting the clinical criteria for post-traumatic stress disorder (PTSD; Abram et al. 2004). Research has also linked PTSD to opioid misuse (Mills et al., 2005). Additionally, these youths have high rates of traumatic brain injuries (Vaughn et al., 2014), which may be a consequence of violence exposure. Substance use can be a coping mechanism to address violence exposure (Hammersley, 2010).

Applying a strain theory framework (Agnew, 2006), we will control for characteristics that have been associated with an increased risk of substance use, including being male (Aarons et al., 2008), being White (Kilpatrick et al., 2000), being older (Wall & Kohl, 2007), violence exposure (Roehler et al., 2017), head injuries (Perron & Howard, 2008; Huw et al. 2010), PTSD (Mills et al., 2005), and being morally disengaged (Newton et al., 2014).

METHODS: Data are from the Pathways to Desistance prospective study of serious juvenile offenders, which includes participants from Phoenix, Arizona (n = 565) and Philadelphia, Pennsylvania (n = 605) (Mulvey, 2016). These data are made available to participating universities by the Inter-university Consortium for Political and Social Research (ICPSR). Study enrollment began in November 2000 and concluded in January 2003. Each participant was followed for seven years until April 2010. Follow-up interviews took place at 6, 12, 18, 24, 30, 36, 48, 60, 72 and 84 months beyond the baseline assessment (http://www.pathwaysstudy.pitt.edu/). Stata 15.1 was used for analyses. Logistic regression was used to model the dichotomous outcome variable, lifetime opioid misuse.

RESULTS: Findings indicate that White youth (OR = 3.89, p< .001) and youth who are morally disengaged (OR = 5.52, p< .001) are the most likely to misuse opioids.

IMPLICATIONS FOR PRACTICE: Study results highlight factors associated with opioid misuse during emerging adulthood for serious violent offenders who were incarcerated as juveniles. Prevention efforts should target moral disengagement. Effective interventions should address opioid use among emerging adults with antisocial tendencies.