Justice system experiences and health risks among Medicaid and uninsured populations receiving treatment for substance use disorder.

introductionWe explored the relationship between justice system experiences and health risks using a sample of Medicaid and uninsured patients in addiction treatment, focusing on four health behaviors correlated with premature mortality: (1) opioid misuse, (2) overdose, (3) multi-substance use, (4) recurrent treatment admissions.

methodsFrom 2021 to 2023, electronic in-depth life-course history surveys were administered in-person with adult patients selected from a community-based public health case management system while undergoing addiction treatment in Michigan, USA. This study utilized a series of logistic regression models to examine the impact of civil and criminal justice predictors on risk for each of the four outcomes of interest.

resultsParticipants were highly vulnerable: seventy percent of participants reported prior homelessness, modal income was $10,000 or less, and nine out of ten reported histories of having been arrested. Participants were more likely to identify as Black or American Indian Alaska Native relative to the broader community, in line with the disproportionate justice system involvement among these communities in Michigan, USA. In logistic regressions, participants with a history of homelessness were 2.16 times as likely to have misused opioids, 2.4 times as likely to have overdosed, and 2.41 times as likely to report multi-substance use relative to peers who had not experienced homelessness (p < 0.01); those with child support obligations were 1.78 times more likely to have misused opioids relative to their peers who did not have a child support obligation (p < 0.05); those who had experienced eviction were 1.8 times as likely to have overdosed and 2.09 times as likely to report multi-substance use compared to peers who did not report eviction history (p < 0.01); and those reporting legal financial obligations (LFOs) were 1.85 times as likely to report multi-substance use (p < 0.05) and 2.28 times as likely to report recurrent treatment admissions (p < 0.05) relative to peers who did not have LFOs.

conclusionsAbsent intervention, these systemic risk factors present barriers to successful recovery and reentry, with ramifications for public health and community-based crime prevention as well as potential to contribute to growing premature mortality among Black and American Indian Alaska Native persons and broader racial health disparities.