Anticipating the Impact of Bail Reform on Connecting People Who Use Drugs to Services upon Reentry in Illinois

Background: Jails can play a key role in addressing the opioid epidemic by linking people who use drugs (PWUD) to treatment during detention, especially in rural areas where access to medication for opioid use disorder (MOUD) is often limited. Illinois became the first U.S. state to abolish the use of cash bail with the implementation of the Pretrial Fairness Act on September 18, 2023. Relatively little research has examined how key stakeholders perceive how bail reform will affect the ability to provide criminal legal involved (CLI) PWUD with MOUD and other health and social services. Our study aims to understand how bail reform may impact the ability of Illinois jails to provide linkage to MOUD. We are of the view that shifting pretrial detention practices in response to bail reform may lead to people cycling more rapidly in and out of facilities, which in turn will create barriers to jails serving as a site for connecting people to MOUD. Findings from this study will provide valuable insights into potential challenges and opportunities for improving access to MOUD within the criminal justice system.

Methods: Semi-structured interviews were conducted with 26 criminal legal system and community stakeholders who work with CLI PWUD in five rural, suburban, and urban IL counties. Interviews were guided by the Consolidated Framework for Implementation Research (CFIR), with a focus on the role of Pretrial Fairness Act as an Outer Setting policy determinant that may impact access to MOUD for CLI PWUD. A six-member coding team conducted a Rapid Qualitative Analysis of interview transcripts to develop a codebook, analyze transcripts, and identify emerging themes. All study activities were approved by the University of Chicago Institutional Review Board.

Results: Participants endorsed varying opinions based on conflicting views of the role of jails as treatment sites. Some expressed concern that bail reform will reduce MOUD access and decrease drug enforcement in concert with rising crime. These views were countered by beliefs that bail reform will end discriminatory income-based detention practices and reduce the risk of jail-based detoxification and post-release overdose in settings where MOUD in jail was not available.

Conclusions and Implications: The range of perspectives on the potential impacts of bail reform underscores that ongoing efforts to expand access to MOUD in carceral facilities alone are insufficient and must coincide with improvements in community-based treatment. Additionally, collaboration between policymakers, healthcare providers, and community organizations is essential to create comprehensive solutions that prioritize both public health and criminal justice reform.