Opioid Abuse and Criminology

“Recent Overdose Experiences in a Community Sample of Military Veterans Who Use Opioids” 

Pouget, Enrique et al. (2017). The Journal of Drug Issues 1-13. Accessed June 17, 2017 

Abstract of Study: Rising rates of overdose mortality underscore the importance of understanding and preventing overdose. We developed a seven-item scale for the assessment of nonfatal opioid-related overdose experiences, adding items on others’ perceptions of whether the participant had overdosed and whether an intervention was attempted to frequently used criteria. We administered the scale to 240 primarily male and minority veterans, recruited using venuebased and chain-referral sampling, who separated from the military post-9/11 and reported current opioid use. The items were internally consistent, and correlated well with overdose risk behaviors (r = .13-.45). The new scale detected overdose events in a significantly higher proportion of participants (36.5%) than that using either self-report criterion (18.2%) or difficulty breathing and losing consciousness criteria (23.8%). These experiences or perceptions should be investigated to inform and better tailor the development of more effective overdose prevention and response programs. 

“An Examination of Women Ex-Offenders With Methadone Histories” 

Majer John, et al. (2015). International Journal of Offender Therapy and Comparative Criminology. Accessed June 27, 2017 

Article Abstract: Criminal (drug and prostitution) charges, employment levels (weekly hours), recent substance use in the past 6 months, and primary sources of income were examined among a sample (n = 106) of women ex-offenders who had opioid use disorders with and without methadone histories. A general linear model was tested to examine differences in relation to methadone use history. Results from a one-way MANCOVA found that those with methadone histories reported significantly higher levels of drug and prostitution charges than those without any methadone history, but no significant differences in terms of weekly hours of employment or recent substance use were observed between groups. Women ex-offenders with methadone histories reported various sources of income beyond employment, and proportionally, more of these women reported prostitution as a primary source of income. Findings suggest that methadone maintenance treatments are not sufficient in meeting the needs of women ex-offenders.

“Paradigm Shift in Responding to Drug Users and Addicts: From a Criminal Justice to a Public Health Approach” 

Anderson James F., et al. (May 2017). International Journal of Social Science Studies Vol. 5, No. 5. Accessed June 27, 2017 

Abstract from Study: Recently, there has been a paradigm shift in the way Americans have come to view drug users and offenders, particularly those affected by the current opioid epidemic. Unlike crack, this epidemic has led to humanistic and compassionate responses to treating the addiction and processing its users. While once stigmatized, demonized, and punished as criminals, today opioid addicts are treated using the medical model. We argue that the new paradigm has ushered in a public health approach, rather than the traditional criminal justice response that brings negative offender processing with adverse consequences. In the end, we believe that the new approach will be effective in treating and reducing opioid use. However, both criminal justice and public health approaches should be applied.

“Exploring synthetic heroin: Accounts of acetyl fentanyl use from a sample of dually diagnosed drug offenders” 

J. Mitchell Miller, et al. (2017). Drug and Alcohol Review.  Accessed June 27, 2017  

Study Abstract: Introduction and Aims. Acetyl fentanyl, a fentanyl analogue emerging onto the recreational drug scene, has been responsible for numerous recent fatal overdoses in the USA, Europe and Russia. Studies reporting acetyl fentanyl use are presently limited to case studies and mortality reports. This study explores the nature of acetyl fentanyl use through the collection of first-hand qualitative data from users to inform public health and drug control policy responses. Design and Methods. A series of focus group interviews within a correctional setting—Delaware County (Ohio) Jail, USA. Participants were 102 individuals in one of two US Bureau of Justice Assistance Second Chance Act substance use treatment initiatives participating in at least one focus group session. Five of these individuals reported acetyl fentanyl use. Semi-structured qualitative focus group sessions queried subjects’ drugs of choice and nature of drug use. Responses were explored through follow-up organic discourse. Results. Acetyl fentanyl users were generally unaware that they had administered the substance until after use (initially believing that they were administering heroin). They described the effects of acetyl fentanyl as stronger and qualitatively different from heroin. These individuals showed no interest in using acetyl fentanyl again describing it as unpleasant and more risky, both because of potency and the threat of a ‘bad batch’. Discussion and Conclusions. Acetyl fentanyl is reaching heroin users, some of which administer it unknowingly. Regulation of acetyl fentanyl is recommended in all countries as is increasing public awareness that the substance is distinct from and being sold as heroin.

“Extended-release naltrexone and drug treatment courts: Policy and evidence for implementing an evidence-based treatment.” 

Allison G. Robertson and Marvin S. Schwartz. (2017) Duke Journal of Substance Abuse Treatment. Accessed June 27, 2017 

Paper Abstract: With insufficient access to treatment and a tradition of criminalizing addiction, people with substance use disorders — including opioid dependence — are more likely to be incarcerated than they are to receive the treatment they need. Drug treatment courts aim to address this problem, engaging their participants in substance use treatment in lieu of incarceration. Drug courts offer an especially important window of opportunity to connect opioid-dependent participants to extended-release naltrexone (XR-NTX), at a time when they are under highly-structured court supervision and required to detoxify from opioids to participate. Given the high cost of XR-NTX and high rates of uninsurance in the drug court population, new rigorous cost-effectiveness evidence is needed to demonstrate the extent to which XR-NTX improves program outcomes, including by reducing recidivism. With that new evidence, drug courts and the counties in which they are situated can make informed and difficult policy decisions about funding XR-NTX for some of their highest-risk community members.

“Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety.” 

Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2009). JAMA : The Journal of the American Medical Association, 301(2), 183–190. Accessed March 8, 2018  

Abstract: Despite increasing evidence that addiction is a treatable disease of the brain, most individuals do not receive treatment. Involvement in the criminal justice system often results from illegal drug-seeking behavior and participation in illegal activities that reflect, in part, disrupted behavior ensuing from brain changes triggered by repeated drug use. Treating drug-involved offenders provides a unique opportunity to decrease substance abuse and reduce associated criminal behavior. Emerging neuroscience has the potential to transform traditional sanction-oriented public safety approaches by providing new therapeutic strategies against addiction that could be used in the criminal justice system. We summarize relevant neuroscientific findings and evidence-based principles of addiction treatment that, if implemented in the criminal justice system, could help improve public heath and reduce criminal behavior.

“Prescription Opioid Abuse in Chronic Pain: A Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse.”

Nalini Sehgal, MD, Laxmaiah Manchikanti, MD, and Howard S. Smith, MD.  (July 20120) Pain Physician 2012; 15:ES67-ES92 • ISSN 2150-1149. Accessed March 8, 2018  

Abstract: Both chronic pain and prescription opioid abuse are prevalent and continue to exact a heavy toll on patients, physicians, and society. Individuals with chronic pain and co-occurring substance use disorders and/or mental health disorders, are at a higher risk for misuse of prescribed opioids. Opioid abuse and misuse occurs for a variety of reasons, including self- medication, use for reward, compulsive use because of addiction, and diversion for profit. Treatment approaches that balance treating chronic pain while minimizing risks for opioid abuse, misuse, and diversion are much needed. The use of chronic opioid therapy for chronic noncancer pain has increased dramatically in the past 2 decades in conjunction with a marked increase in the abuse of prescribed opioids and accidental opioid overdoses. Consequently, a validated screening instrument that provides an effective and rational method of selecting patients for opioid therapy, predicting risk, and identifying problems once they arise could be of enormous benefit. Such an instrument could potentially curb the risk of iatrogenic addiction. Although several screening instruments and strategies have been introduced in the past decade, there is no single test or instrument that can reliably and accurately predict patients who are not suitable for opioid therapy or identify those who need increased vigilance or monitoring during therapy. At present, screening for opioid abuse includes assessment of premorbid and comorbid substance abuse; assessment of aberrant drug-related behaviors; risk factor stratification; and utilization of opioid assessment screening tools. Multiple opioid assessment screening tools and instruments have been developed by various authors. In addition, urine drug testing, monitoring of prescribing practices, prescription monitoring programs, opioid treatment agreements, and utilization of universal precautions are essential. Presently, a combination of strategies is recommended to stratify risk, identify and understand aberrant drug related behaviors, and tailor treatments accordingly. This manuscript will review the current state of knowledge regarding the growing problem of opioid abuse and misuse; known risk factors; and methods of predicting, assessing, monitoring, and addressing opioid abuse and misuse in patients with chronic noncancer pain.