Pharmacotherapy Improves Criminal Justice Outcomes in Opioid Dependence With Mental Illness
Researchers investigated the effects of methadone, buprenorphine, and oral naltrexone on clinical and justice-related outcomes in adults with serious mental illness.
Pharmacotherapy for opioid dependence in adults suffering from a serious mental illness who spent at least 1 night in jail between 2002 and 2009 reduced crisis-driven service utilization including inpatient hospitalization, according to the results of a study published in the Journal of Substance Abuse Treatment.
Allison G. Robertson, MPH, PhD, of the Department of Psychiatry & Behavioral Sciences from Duke University School of Medicine in Durham, North Carolina, and colleagues investigated the effects of methadone, buprenorphine, and oral naltrexone on clinical and justice-related outcomes in adults with serious mental illness, opioid dependence, and criminal justice involvement.
The investigators merged administrative data from several public agencies in Connecticut of 8736 adults (aged 18 or older) with schizophrenia spectrum disorder, bipolar disorder, or major depression co-occurring with moderate to severe opioid dependence who had spent at least 1 night in jail between 2002 and 2009.
They used longitudinal multivariable regression models to estimate the effect of opioid-dependence pharmacotherapy compared with outpatient substance abuse treatment without opioid-dependence pharmacotherapy on inpatient substance abuse or mental health treatment, emergency department visits, criminal convictions, and incarcerations. Instances of each outcome were analyzed 12 months before and after an index treatment episode.
All 3 opioid-dependence pharmacotherapies — methadone, buprenorphine, and oral naltrexone — were associated with reductions in inpatient substance abuse treatment. Patients treated with oral naltrexone also experienced a reduction in inpatient mental health treatment as well as improved adherence to medication regimens for serious mental illness. Overall, the opioid-dependence pharmacotherapy group had higher rates of arrest and incarceration in the follow-up period than the comparison group, but patients using naltrexone had lower rates of arrests, including felonies.
The investigators concluded that there were significant associations between opioid-dependence pharmacotherapy and reductions in crisis-driven service utilization — particularly in inpatient hospitalization — demonstrated by their analyses. They also suggested that given the large reductions in service utilization associated with pharmacotherapy in this study, using evidence-based medications for treating opioid dependence can be successful in adults with serious mental illness and may reduce not only the individual burden but also the societal cost of these complex issues.
The researchers called for studies to better understand how to reduce barriers to opioid-dependence pharmacotherapy in this population and to improve prescribing rates.
Robertson AG, Easter MM, Lin H-J, Frisman LK, Swanson JW, Swartz MS. Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness. J Subst Abuse Treat. 2018;86:17-25.