Improving Health Equity, Recidivism, and Engagement of Persons Addicted to Opioids

Background: Opioid misuse presents significant issues related to criminal justice, equitable access to services, adverse health outcomes concerns, economic distress, and potentially death. We investigated the intersections of opioid misuse and the criminal justice system by evaluating three aspects of the Empowered Communities Opioid Project (ECOP) focusing on: reducing recidivism, improving engagement, and improving health outcomes. The study’s hypothesis was that the ECOP would improve these aspects for individuals with opioid use disorder (OUD).

Methods: Using an iterative complex systems approach, primary data were gathered from a control group and an intervention group. In order for participants to be accepted into the program, they had a history of opioid use and a non-violent criminal history. Prior to admission, participants indicated their interest in working with a peer navigator and chose as to whether or not they wanted to opt-in or opt-out services. As a result, researchers observed a sample size of n=89 individuals who participated in ECOP. They also observed participants in the control group who opted out of services and those who were wait-listed. To improve effectiveness a number of tools were used to understand the causal relationship between treatment plans and recidivism.

We utilized the Assess an Individual (AAI) tool, a 22-question assessment covering demographics, criminal justice risk, substance use, criminal thinking, mental health, and lifestyle stability. These responses were cross-referenced to a databased of 25,000 profiles maintained by the Advance Correctional Excellence (ACE) which contains information generated from the risk-needs-responsivity simulation tool (RNR). The RNR assesses participants’ risk to the criminal justice system, their need for programs that serve them, and their responsivity to those programs. Matching AAI responses to the profiles enabled the ECOP to identify which treatments were most effective to participants. A 13-item questionnaire - covering medical and behavioral health issues, criminal justice contact, social and economic outcomes (including access to food, housing, and employment) - was administered to the control and intervention groups during in-take, 1-month, 6-months, and 12-months.

Results: Of the 89 participants, females maintained higher program involvement as they accounted for (59.3%) of reassessments. In the domains of recidivism, health outcomes, and engagement statistically significant improvements were realized (alpha <.05). Opioid misuse decreased significantly for those at the 6-month and 12-month periods. The majority reported misuse at either initial intake or one month into the program while only four reported misuse by the 12-month period. Twenty-eight had either law enforcement contact (n=17; 19%) or been arrested (n=19; 21.3%). Likewise, law enforcement contacts decreased asymptotically at 6-months and 12-months. Large percentages (96%) strongly agree that they trust their peer support coordinator.

Implications: Interventions reducing the likelihood of opioid users interacting with the criminal justice system are needed. This study demonstrates that apply a complex systems approach because it identifies the interconnectedness of the problem in reducing recidivism, improving engagement, and improving health outcomes.