An investigation of drug use among first-time arrestees from 25 county jails across the United States in 2023

American Psychiatric Association

West K.L., Lindquist K., Rodda L.N.

Opioid-use disorders have led to a nationwide epidemic of accidental overdoses in the United States. In recent years this opioid epidemic has worsened due to the increased availability of fentanyl in the illicit drug market. The increase in fentanyl-related deaths is well known on the U.S. East Coast, however, limited comprehensive information of mortality data exists from major West Coast cities.Following comprehensive medico-legal death and toxicological investigations, a retrospective cohort study was performed on all accidental opioid overdose deaths (AOOD) from 2009 - 2019 in San Francisco. The sex, age and race of decedents, location, and date and time of death were described and statistically compared by the type of opioid(s) causing death.Since 2016, fentanyl deaths started to replace heroin deaths leading to a sharp increase in fatal overdoses involving fentanyl, surpassing heroin and/or medicinal opioids by 2018. Fentanyl contributed to between 3% and 12% of deaths per year from 2009 to 2015, and between 20% and 73% per year from 2016 to 2019. White and Black males represented 91.5% of all AOOD. Age groups younger than 45 died using fentanyl and heroin significantly more often than older populations (60.7% of ≤45 vs. 40.7% of >45 year-olds, χ2p

Mital S., Wolff J., Carroll J.J.

Introduction Rates of opioid overdose (OD) have risen to unprecedented numbers and more than half of incarcerated individuals meet the criteria for substance use disorder, placing them at high risk. This review describes the relationship between incarceration history and OD. Methods A scoping review was conducted and criteria for inclusion were: set in North America, published in English, and non-experimental study of formerly incarcerated individuals. Due to inconsistent definitions of opioid OD, we included all studies examining OD where opioids were mentioned. Results The 18 included studies were all published in 2001 or later. Four associations between incarceration history and OD were identified: (1) six studies assessed incarceration history as a risk factor for OD and four found a significantly higher risk of OD among individuals with a history of incarceration compared to those without; (2) nine studies examined the rate of OD compared to the general population: eight found a significantly higher risk of fatal OD among those with a history of incarceration and three documented the highest risk of death immediately following release; (3) six studies found demographic, substance use and mental health, and incarceration-related risk factors for OD among formerly incarcerated individuals; and (4) four studies assessed the proportion of deaths due to OD and found a range from 5 % to 57 % among formerly incarcerated individuals. Discussion Findings support the growing call for large-scale implementation of evidence-based OD prevention interventions in correctional settings and among justice-involved populations to reduce OD burden in this high-risk population.

Stickle B., Felson M.

The COVID-19 pandemic of 2020 has impacted the world in ways not seen in generations. Initial evidence suggests one of the effects is crime rates, which appear to have fallen drastically in many communities around the world. We argue that the principal reason for the change is the government ordered stay-at-home orders, which impacted the routine activities of entire populations. Because these orders impacted countries, states, and communities at different times and in different ways, a naturally occurring, quasi-randomized control experiment has unfolded, allowing the testing of criminological theories as never before. Using new and traditional data sources made available as a result of the pandemic criminologists are equipped to study crime in society as never before. We encourage researchers to study specific types of crime, in a temporal fashion (following the stay-at-home orders), and placed-based. The results will reveal not only why, where, when, and to what extent crime changed, but also how to influence future crime reduction.

Fiscella K., Noonan M., Leonard S.H., Farah S., Sanders M., Wakeman S.E., Savolainen J.

Drugs and alcohol are the third leading cause of death in U.S. jails. We analyzed 2000 to 2013 national jail mortality data by coding text data. We identified 1,442 deaths associated with drugs and...

Brinkley-Rubinstein L., Peterson M., Clarke J., Macmadu A., Truong A., Pognon K., Parker M., Marshall B.D., Green T., Martin R., Stein L., Rich J.D.

The prevalence of opioid use disorders among people who are incarcerated is high. People who are released from incarceration are at increased risk for overdose. The current study details the first year of implementation of a state-wide medications for addiction treatment (MAT) program in a unified jail and prison setting at the Rhode Island Department of Corrections in Cranston, Rhode Island. We conducted 40 semi-structured, qualitative interviews with people who were incarcerated and concurrently enrolled in the MAT program. Analysis employed a general, inductive approach in NVivo 12. We found that a majority of participants discussed program benefits such as reduced withdrawal symptoms, decreased prevalence of illicit drug use in the facility, improved general environment at the RIDOC, and increased post-release intentions to continue MAT. Suggested areas of improvement include reducing delays to first dose, increasing access to other recovery services in combination with MAT, improving staff training on stigma, and earlier access to medical discharge planning information prior to release. Our findings suggest that correctional MAT programs are acceptable to targeted populations and are a feasible intervention that may be transferable to other states.

Bravoco J.

Opioid use disorder (OUD) is a complex condition requiring a multifaceted treatment approach. As such, a variety of different models, both pharmacologic and non-pharmacologic, have been proposed and ultimately implemented as part of standard clinical practice over the past several decades, each providing a specific focus and expected therapeutic outcome. This chapter will take a closer look at such clinical approaches in their respective historical contexts, highlighting both their similarities and differences, while emphasizing the ongoing evolution of clinical approaches to an alarming and ever-changing public health crisis.

Zaller N., Donadeo K., Coffey J., Zielinski M., Brinkley-Rubinstein L.

Individuals who have experienced incarceration have an increased risk of both fatal and nonfatal overdose. Given the increases in illicit opioid use in Arkansas and across the South, many individuals with opioid use disorder (OUD) are likely to encounter the criminal justice system, particularly county jails. However, there are currently no published data on OUD among entrants into county jails in the South. This study presents data from an OUD screening project initiated by the Pulaski County Regional Detention Facility, the largest county jail in the state of Arkansas. As part of the regular intake process, a jail staff person administered the Rapid Opioid Dependence Screen. De-identified data were provided to researchers at the University of Arkansas for Medical Sciences. The data clearly show an increased prevalence of OUD, justifying the need for evidence-based substance use programs such as MAT in jail settings in the South.

Moore K.E., Oberleitner L., Pittman B.P., Roberts W., Verplaetse T.L., Hacker R.L., Peltier M.R., McKee S.A.

Current national prevalence estimates of DSM-5 diagnosed substance use disorders (SUDs) among adults with justice system involvement are lacking.This study drew from NESARC-III data (n = 36,309; 2012-2013), a nationally representative U.S. sample, to examine current and lifetime alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses among adults reporting current or prior drug-related, alcohol-related, and general legal problems.Adults reporting current alcohol-related legal problems were 22 times more likely to have a current AUD diagnosis (AOR = 22.0, 95% CI = 12.1; 40.1) and 15 times more likely to have had a lifetime AUD diagnosis (AOR = 15.2, 95% CI = 7.5; 30.9) than adults without alcohol-related legal problems. Adults with lifetime drug-related legal problems were 3-5 times more likely to have a current (AOR = 2.6, 95% CI = 2.1; 3.2) and lifetime (AOR = 5.1, 95% CI = 4.3; 6.1) DUD diagnosis, with stimulant use disorder being the most prevalent (AOR = 5.4, 95% CI = 4.5; 6.5). Adults with general legal problems were around 3 times more likely to have a current AUD (AOR = 3.2, 95% CI = 2.6; 4.0) or DUD (AOR = 3.5, 95% CI = 2.8; 4.4). Women with any type of legal problem were more likely to have SUD diagnoses than men.SUD diagnoses are prevalent among adults reporting legal problems, particularly those involving alcohol. There is a continued need for community-based addiction prevention and intervention efforts, especially for women with justice system involvement.

Camplain R., Warren M., Baldwin J.A., Camplain C., Fofanov V.Y., Trotter R.T.

Each year, 9 million individuals cycle in and out of jails. The under-characterization of incarceration as an exposure poses substantial challenges to understanding how varying levels of exposure to jail may affect health. Thus, we characterized levels of jail incarceration including recidivism, number of incarcerations, total and average number of days incarcerated, and time to reincarceration.We created a cohort of 75,203 individuals incarcerated at the Coconino County Detention Facility in Flagstaff, Arizona, from 2001 to 2018 from jail intake and release records.The median number of incarcerations during the study period was one (interquartile range [IQR] = 1-2). Forty percent of individuals had >1 incarceration. The median length of stay for first observed incarcerations was 1 day (IQR = 0-5). The median total days incarcerated was 3 (IQR = 1-23). Average length of stay increased by number of incarcerations. By 18 months, 27% of our sample had been reincarcerated.Characteristics of jail incarceration have been largely left out of public health research. A better understanding of jail incarcerations can help design analyses to assess health outcomes of individuals incarcerated in jail. Our study is an early step in shaping an understanding of jail incarceration as an exposure for future epidemiologic research. See video abstract at, http://links.lww.com/EDE/B536.

Trotter II R.T., Camplain R., Eaves E.R., Fofanov V.Y., Dmitrieva N.O., Hepp C.M., Warren M., Barrios B.A., Pagel N., Mayer A., Baldwin J.A.

Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations.This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization.The project has two processes-a secondary data analysis and primary data collection-which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the "honest broker" system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants.To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome.This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates.RR1-10.2196/10337.

Jalal H., Buchanich J.M., Roberts M.S., Balmert L.C., Zhang K., Burke D.S.

Analyzing the drug abuse epidemic There is a developing drug epidemic in the United States. Jalal et al. analyzed nearly 600,000 unintentional drug overdoses over a 38-year period. Although the overall mortality rate closely followed an exponential growth curve, the pattern itself is a composite of several underlying subepidemics of different drugs. Geographic hotspots have developed over time, as well as drug-specific demographic differences. Science , this issue p. eaau1184

Ashton H.

The reasons for women in Europe and North America being prescribed over twice as many psychotropic drugs as men are complex. Psychiatric disorders such as depression and anxiety appear to be more common in women than in men, and women more commonly complain of psychological symptoms. There may be a gender bias in medical diagnosis and choice of medication. Sociological factors may also be involved, including the likelihood that women have fewer outlets than men for symptom control by activities outside the home (e.g. the social use of alcohol). Women also have special problems including pregnancy, lactation, child rearing and pre-menstrual tension. Probably, much use of psychotropic-drug use for women (and men) is inappropriate and not closely related to the symptoms or conditions for which they are prescribed. Furthermore, the chronic use of some psychotropic drugs, especially benzodiazepines, may compound the problem by inducing dependence and withdrawal symptoms.

Staton M., Strickland J.C., Webster J.M., Leukefeld C., Oser C., Pike E.

Rural women are at risk for health consequences (such as HIV) associated with substance misuse, but targeted interventions are limited for this population. Jails provide an underutilized opportunity for outreach to high-risk women in rural Appalachian communities. Rural women were randomized to either the NIDA Standard education intervention (n = 201) or the NIDA Standard plus motivational interviewing (MI-HIV; n = 199) while in jail. Outcomes focused on HIV risk behaviors 3 months post-release from jail. Decreases in HIV risk behaviors were observed at follow-up across conditions. Although participants in the MI-HIV group showed reductions in outcomes compared to the NIDA Standard group (OR = 0.82–0.93), these estimates did not reach significance (p values > .57). HIV education interventions can be associated with risk-reduction behaviors. These findings support the need for increased access to prevention education in criminal justice venues, particularly in rural communities.

Choi N.G., DiNitto D.M., Marti C.N.

This study examined age group differences in and correlates of treatment use and perceived treatment need for substance use disorders (SUD) and mental health (MH) problems as well as self-reported barriers to treatment among people 65+ years old vs. 26-34, 35-49, and 50-64 years old.Data are from the 2008 to 2012 National Survey on Drug Use and Health (NSDUH) (N = 96,966). Age group differences were examined using descriptive bivariate analyses and binary logistic regression analyses.The 65+ age group was least likely to use treatment and perceive treatment need, but the 50-64 age group was more similar to the younger age groups than the 65+ age group. Controlling for age, other predisposing, and enabling factors, alcohol and illicit drug dependence and comorbid SUD and MH problems increased the odds of SUD treatment use. Of MH problems, anxiety disorder had the largest odds for MH treatment use. Bivariate analyses showed that lack of readiness to stop using and cost/limited insurance were the most frequent barriers to SUD and MH treatment, respectively, among older adults, and they were less likely than younger age groups to report stigma/confidentiality concerns for MH treatment.Older adults will become a larger portion of the total U.S. population with SUD and/or MH problems. Healthcare providers should be alert to the need to help older adults with SUD and/or MH problems obtain treatment.