Using Actor-Partner Interdependence Modeling to Understand Recent Illicit Opioid Use and Injection Drug Use Among Men in Community Supervision and Their Female Partners in New York City

Background: The United States’ opioid crisis disproportionately affects individuals in the criminal justice system. Although increasing attention is being paid to incarcerated individuals, the largest part of the criminal justice system – community supervision – remains overlooked. People of color, particularly African-Americans, are disproportionately represented in community supervision settings. Intimate partners can be a source of social support that helps reduce substance use, or they can serve as a driver of continued or increased substance use. Better understanding of the association between intimate partner characteristics and illicit opioid use and injection drug use among individuals in community supervision could be vital to developing targeted interventions.

Methods: Using actor-partner interdependence models, we examined individual and partner characteristics associated with recent illicit opioid use and injection drug use among males in community supervision settings in New York City (n=229) and their female partners (n=229). The population was primarily non-Hispanic black (74.0%) and Hispanic (19.0%).

Results: Several mental health factors were found to have actor effects for recent illicit opioid use, especially for men. Higher levels of depression (aOR 1.98, 95% CI [1.39-2.82], p≤0.01), anxiety (aOR 1.98, 95% CI [1.42-2.75], p≤0.01), and stressful life events (aOR 1.15, 95% CI [1.04-1.26], p≤0.01) were associated with recent opioid use among males in community supervision. These factors, along with PTSD, were also associated with recent injection drug use among males. Females who had ever been hospitalized for mental health or emotional reasons were more likely to have recently used illicit opioids (aOR 2.59, 95% CI 2.59 [1.02-6.60], p≤0.05). Mental health factors also had partner effects. Females with a partner having higher levels of anxiety were more likely to have recently used opioids (aOR 1.52, 95% CI [1.06-2.16], p≤0.05). Males with a partner having higher levels of anxiety were also more likely to have recently used opioids (aOR 1.38 [1.03-1.85], p≤0.05). Males with a female partner with higher levels of anxiety (aOR 2.16, 95% CI [1.31-3.56], p≤0.01) or depression (aOR 1.70, 95% CI [1.01-2.86], p≤0.05) were more likely to recently inject drugs.

Conclusions: Results suggest that recent individual illicit opioid use and injection drug use are associated not only with individual-level factors, but also with partner characteristics. While it is recommended that individuals with co-occurring mental health and opioid use disorder (OUD) receive treatment for both disorders at the same time, unfortunately, treatment for OUD and mental health problems are rarely integrated in the current U.S. health system. Furthermore, our results indicate the mental health status of intimate partners was also associated with recent illicit opioid use and injection drug use, but intimate partner mental health disorders are rarely considered in treatment plans for individuals with OUD. As we move forward to address the opioid epidemic in the United States, we should strive to develop interventions and programs that address factors at multiple levels, including the dyad-level.