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Drug Alcohol Depend. 2019 Jan 1;194:482-486. doi: 10.1016/j.drugalcdep.2018.10.035. Epub 2018 Dec 3.

Incidence of future arrests in adults involved in the criminal justice system with opioid use disorder receiving extended release naltrexone compared to treatment as usual.

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Department of Emergency Medicine, Baystate Medical Center, 3601 Main St., Springfield, MA 01199, United States. Electronic address:
Department of Biostatistics, Baystate Medical Center, 3601 Main St., Springfield, MA 01199, United States. Electronic address:
Friends Research Institute, 1040 Park Avenue, Baltimore, MD 21201, United States. Electronic address:
Department of Population Health, New York University, 227 E. 30th St., New York, NY 10016, United States. Electronic address:
Columbia University Medical Center, 617 West End Avenue, New York, NY 10024, United States. Electronic address:
Department of Psychiatry, University of Pennsylvania, Department of Behavior Health, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States. Electronic address:
Stony Brook University, 100 Nicolls Rd., Stony Brook, NY 11794, United States. Electronic address:
Department of Academic Affairs, Baystate Medical Center, 3601 Main St., Springfield, MA 01199, United States. Electronic address:



Criminal justice involved (CJS) populations with opioid use disorder (OUD) have high rates of relapse, future arrests, and death upon release. While medication for OUD (MOUD) reduces opioid relapse, concerns regarding diversion and stigma limit treatment in CJS populations. Extended release naltrexone (XR-NTX), as an opioid antagonist, may be more acceptable to CJS administrators. However, the impact of XR-NTX on criminal recidivism remains unknown.


Arrest data from a published randomized trial comparing XR-NTX to treatment as usual (TAU) was captured by self-report and official state arrest records. Comparisons of future arrests, time to first arrest and total number of arrests were performed using chi square tests and multivariable generalized regression models. Secondary outcomes explored differences in arrests by type and severity of crime, use of opioid and other drugs, and study phase.


Of 308 participants randomized, 300 had arrest data. The incidence of arrests did not differ between XR-NTX (47.6%) and TAU (42.5%) participants. (ChiSq p = 0.37). Additionally, there was no significant difference in time to first arrest (adjusted HR 1.35, CI 0.96-1.89) and number of arrests per participant (adjusted IR 1.33, CI 0.78-2.27). Controlling for gender, age, previous criminal activity, and use of non-opioid drugs, logistic regression demonstrated no significant difference in incidence of arrests between groups (adjusted OR 1.38, 95% CI 0.85-2.22).


We detected no significant difference in arrests between CJS participants with OUD randomized to XR-NTX or TAU. Despite its efficacy in reducing opioid use, XR-NTX alone may be insufficient to reduce criminal recidivism.


Criminal recidivism; Extended release naltrexone; Opioid use disorder

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