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State criminal justice policy context and opioid agonist treatment delivery among opioid treatment admissions, 2015
زمینه سیاست عدالت کیفری ایالتی و تحویل درمان آگونیست مواد افیونی در بین پذیرش های درمان مواد افیونی ، 2015-2020 Background: Criminal justice referral to treatment is associated with reduced odds of receiving opioid agonist
treatment (OAT), the gold-standard treatment for opioid use disorder. States vary substantially in the extent of
criminal justice system involvement in opioid treatment; however, the effects on treatment provision are not
clear. We examined whether state-level criminal justice involvement in the substance use treatment system
modified the association between criminal justice referral to treatment and OAT provision among opioid
treatment admissions.
Methods: We conducted a random effects logistic regression to investigate how the effects of criminal justice
referral to treatment on OAT provision differed in states with high vs. low state-level criminal justice involvement
in opioid treatment, adjusting for individual and state-level covariates, among 22 states in the 2015
Treatment Episode Dataset-Admissions.
Results: Criminal justice referral to treatment was associated with an 85% reduction in the odds of receiving
OAT, compared to other sources of treatment referral (OR=0.15; 95% CI: 0.15, 0.16). Among opioid treatment
admissions resulting from criminal justice referral in 2015, receiving treatment in high criminal justice involvement
states was associated with a 63% reduction in the odds of OAT provision, compared to opioid
treatment received in low criminal justice involvement states (interaction OR=0.37, 95% CI: 0.11, 0.89).
Conclusion: The effects of criminal justice referral to treatment on OAT provision varied by criminal justice
involvement in opioid treatment at the state level. Targeted interventions should increase access to OAT in states
that rely on the criminal justice system for opioid treatment referrals. Keywords: Criminal justice | Opioid agonist treatment (OAT) | Opioid use disorder | Substance use treatment access | State policy | Medication assisted treatment | Methadone | Buprenorphine | Medication for opioid use disorder |
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