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Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness.

Publication ,  Journal Article
Robertson, AG; Easter, MM; Lin, H-J; Frisman, LK; Swanson, JW; Swartz, MS
Published in: J Subst Abuse Treat
March 2018

Adults suffering from a serious mental illness (SMI) and a substance use disorder are at especially high risk for poor clinical outcomes and also arrest and incarceration. Pharmacotherapies for treating opioid dependence could be a particularly important mode of treatment for opioid-dependent adults with SMI to lower their risk for overdose, high-cost hospitalizations, repeated emergency department visits, and incarceration, given relapse rates are very high following detoxification in the absence of one of the three FDA-approved pharmacotherapies. This study estimates the effects of methadone, buprenorphine, and oral naltrexone on clinical and justice-related outcomes in a sample of justice-involved adults with SMI, opioid dependence, and criminal justice involvement. Administrative data were merged from several public agencies in Connecticut for 8736 adults 18years of age or older with schizophrenia spectrum disorder, bipolar disorder, or major depression; co-occurring moderate to severe opioid dependence; and who also had at least one night in jail during 2002-2009. Longitudinal multivariable regression models estimated the effect of opioid-dependence pharmacotherapy as compared to outpatient substance abuse treatment without opioid-dependence pharmacotherapy on inpatient substance abuse or mental health treatment, emergency department visits, criminal convictions, and incarcerations, analyzing instances of each outcome 12months before and after an index treatment episode. Several baseline differences between the study groups (opioid-dependence pharmacotherapy group versus outpatient treatment without opioid-dependence pharmacotherapy) were adjusted for in the regression models. All three opioid-dependence pharmacotherapies were associated with reductions in inpatient substance abuse treatment, and among the oral naltrexone subgroup, also reductions in inpatient mental health treatment, as well as improved adherence to SMI medications. Overall, the opioid-dependence pharmacotherapy group had higher rates of arrest and incarceration in the follow-up period than the comparison group; but those using oral naltrexone had lower rates of arrest (including felonies). The analysis of observational administrative data provides useful population-level estimates but also has important limitations that preclude conclusive causal inferences. Large reductions in crisis-driven service utilization associated with opioid-dependence pharmacotherapy in this study suggest that evidence-based medications for treating opioid dependence can be used successfully in adults with SMI and should be considered more systematically during assessments of treatment needs for this population.

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Published In

J Subst Abuse Treat

DOI

EISSN

1873-6483

Publication Date

March 2018

Volume

86

Start / End Page

17 / 25

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Substance Abuse
  • Opioid-Related Disorders
  • Narcotic Antagonists
  • Mental Disorders
  • Male
  • Humans
  • Female
  • Criminals
  • Connecticut
 

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APA
Chicago
ICMJE
MLA
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Robertson, A. G., Easter, M. M., Lin, H.-J., Frisman, L. K., Swanson, J. W., & Swartz, M. S. (2018). Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness. J Subst Abuse Treat, 86, 17–25. https://doi.org/10.1016/j.jsat.2017.12.003
Robertson, Allison G., Michele M. Easter, Hsiu-Ju Lin, Linda K. Frisman, Jeffrey W. Swanson, and Marvin S. Swartz. “Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness.J Subst Abuse Treat 86 (March 2018): 17–25. https://doi.org/10.1016/j.jsat.2017.12.003.
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 Mar;86:17–25.
Robertson, Allison G., et al. “Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness.J Subst Abuse Treat, vol. 86, Mar. 2018, pp. 17–25. Pubmed, doi:10.1016/j.jsat.2017.12.003.
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 Mar;86:17–25.
Journal cover image

Published In

J Subst Abuse Treat

DOI

EISSN

1873-6483

Publication Date

March 2018

Volume

86

Start / End Page

17 / 25

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Substance Abuse
  • Opioid-Related Disorders
  • Narcotic Antagonists
  • Mental Disorders
  • Male
  • Humans
  • Female
  • Criminals
  • Connecticut