Abstract
Incarceration poses significant health risks for people involved in the criminal justice system. As the world's leader in incarceration, the United States incarcerated population is at higher risk for infectious diseases, mental illness, and substance use disorder. Previous studies indicate that the mortality rate for people coming out of prison is almost 13 times higher than that of the general population; opioids contribute to nearly 1 in 8 post-release fatalities overall, and almost half of all overdose deaths. Given the hazardous intersection of incarceration, opioid use disorder, and social determinants of health, we systematically reviewed recent evidence on interventions for opioid use disorder (OUD) implemented as part of United States criminal justice system involvement, with an emphasis on social determinants of health (SDOH). We searched academic literature to identify eligible studies of an intervention for OUD that was implemented in the context of criminal justice system involvement (e.g., incarceration or parole/probation) for adults ages 19 and older. From 6,604 citations, 13 publications were included in final synthesis. Most interventions were implemented in prisons (n = 6 interventions), used medication interventions (n = 10), and did not include SDOH as part of the study design (n = 8). Interventions that initiated medication treatment early and throughout incarceration had significant, positive effects on opioid use outcomes. Evidence supports medication treatment administered throughout the period of criminal justice involvement as an effective method of improving post-release outcomes in individuals with criminal justice involvement. While few studies included SDOH components, many investigators recognized SDOH needs as competing priorities among justice-involved individuals. This review suggests an evidence gap; evidence-based interventions that address OUD and SDOH in the context of criminal justice involvement are urgently needed.
Highlights
In the United States, the prison incarceration rate is the highest in the world at 655 per 100,000 [1]
We conducted a search of academic literature on May 6, 2019 to identify interventions for people with opioid use disorder (OUD) implemented during incarceration following PRISMA standards for systematic reviews [33]
In a systematic review of the evidence, we identified a range of evidence-based options to support people with OUD who are incarcerated or recently released from incarceration in the U
Summary
In the United States, the prison incarceration rate is the highest in the world at 655 per 100,000 [1]. In Washington State, for example, when compared with the general population, people reentering society from prison have a mortality rate nearly 13 times higher within the first two weeks post-release [3]. While multifactorial, this high mortality rate was driven largely by opioids, which were involved in approximately 1 in 8 post-release fatalities overall and over half of all overdose deaths [2,3]. Similar results were found in a more recent North Carolina study, in which the relative risk of opioid overdose death was 40 times higher than that of the general population within the first two weeks of release [12]
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