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Drug misuse and the range of social problems associated with it fall heavily within the purview of the American criminal justice system. Individuals struggling with substance use disorders are often arrested for possessing illegal drugs, committing property offenses to buy them, or for the disruptive behaviors caused by them. Following legislation in the last 20 years aimed at reducing state prison populations, individuals convicted of drug-related crimes are increasingly sentenced to community supervision. This policy shift has occurred as the U.S. has been grappling with a prolonged opioid crisis. Populations under criminal justice system control are at markedly high risk for a range of poor health outcomes, including overdose death. While those under community supervision misusing opioids may be at uniquely high risk, there is limited research knowledge to guide intervention. This study seeks to document the prevalence of opioid misuse within the community supervised population and to examine correlates of use using a well-characterized national data source. The goal of this study is to help build toward an evidence-based approach to addressing the service needs of an underserved, high-risk segment of the criminal justice involved population.
Methods
We used data from the National Survey on Drug Use and Health (NSDUH) collected between 2015 and 2020. The NSDUH is a nationally representative, cross-sectional household survey conducted annually in all 50 U.S. states and the District of Columbia. Using a multi-stage probability sampling design, the NSDUH samples from civilian, noninstitutionalized U.S. residents. It provides national estimates for a wide range of variables related to substance use, mental health, and other health-related issues. Our study sample included 5,154 adults on probation or parole. Measures included past year opioid misuse and several correlates measuring mental health, substance abuse, risk behaviors, and treatment receipt. We conducted a series of logistic regressions to examine the association between past year opioid misuse and these correlates while controlling for socio-demographics and survey year. Statistical analyses were weighted to account for the NSDUH’s stratified cluster sampling design.
Results
Opioid misuse by this population is 4 times higher than in the general population. Nearly 1 in 5 individuals on probation or parole reported misusing opioids in the past year. Being White and living in poverty doubled the likelihood of opioid misuse. Those who misused opioids had significantly worse mental and behavioral health outcomes when compared to others under community supervision. These included binge drinking, driving under the influence, polysubstance misuse, major depressive episodes, serious psychological distress, and substance use disorder, raising concerns for both public health and public safety.
Conclusions and Implications
We conjecture that the strikingly elevated rates of health risk behaviors by those who misuse opioids may help explain, in part, elevated rates of disability and premature death for individuals under community supervision. Our findings highlight the primary role of substance misuse treatment for improving health and safety outcomes for this population as well as for successfully reducing prison populations.