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Addict Behav. 2018 Nov;86:104-110. doi: 10.1016/j.addbeh.2018.02.024. Epub 2018 Feb 24.

Criminal justice continuum for opioid users at risk of overdose.

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Department of Social Medicine, University of North Carolina, Chapel Hill, United States; Center for Health Equity Research, University of North Carolina, Chapel Hill, United States. Electronic address:
University of Arkansas Medical Sciences, United States.
Center for Prisoner Health and Human Rights, Miriam Hospital, Providence, RI, United States.
Emory University, United States; Vera Institute of Justice, United States.
Cornell University, Ithaca, NY, United States.
Center for Health Equity Research, University of North Carolina, Chapel Hill, United States.
Tulane University School of Public Health and Tropical Medicine, United States.


The United States (US) is in the midst of an epidemic of opioid use; however, overdose mortality disproportionately affects certain subgroups. For example, more than half of state prisoners and approximately two-thirds of county jail detainees report issues with substance use. Overdose is one of the leading causes of mortality among individuals released from correctional settings. Even though the criminal justice (CJ) system interacts with a disproportionately high number of individuals at risk of opioid use and overdose, few CJ agencies screen for opioid use disorder (OUD). Even less provide access to medication assisted treatment (e.g. methadone, buprenorphine, and depot naltrexone), which is one of the most effective tools to combat addiction and lower overdose risk. However, there is an opportunity to implement programs across the CJ continuum in collaboration with law enforcement, courts, correctional facilities, community service providers, and probation and parole. In the current paper, we introduce the concept of a "CJ Continuum of Care for Opioid Users at Risk of Overdose", grounded by the Sequential Intercept Model. We present each step on the CJ Continuum and include a general overview and highlight opportunities for: 1) screening for OUD and overdose risk, 2) treatment and/or diversion, and 3) overdose prevention and naloxone provision.


Criminal justice; Opioid overdose

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