A longitudinal look at factors associated with arrest and incarceration among Medicaid beneficiaries with opioid addiction

Background: Individuals with opioid dependence have high rates of arrests and incarceration, however the impact of opioid agonist treatment on criminal justice involvement over time is not well understood. Understanding how treatment type and duration affect criminal offending is particularly important in light of various state policies that limit access to long-term treatment.

Methods: Service utilization claims and lifetime records of arrest and incarceration were linked and Massachusetts Medicaid beneficiaries with opioid dependence were followed for up to seven years. After creating episodes of buprenorphine, methadone or other treatment, we used survival models to measure associations of demographics, comorbidities, criminal justice history and duration of current and previous treatment exposure with arrest and incarceration.

Results: We followed 56,278 individuals with 104, 840 treatment episodes between 2004 and 2010. The risk of criminal justice encounters increased throughout the study period. First episodes and longer episodes of current treatment were associated with significantly lower risk of arrest or incarceration. Individuals were at greater risk during episodes of buprenorphine or methadone treatment, but cumulative exposure to opioid agonist treatment reduced risk compared with other treatment. Temporal factors and comorbidities were also associated with criminal justice risk.

Conclusions: A longitudinal perspective shows that criminal offending is common among individuals with opioid addiction regardless of treatment status. Policies and practices that encourage individuals to enter treatment early and remain in opioid agonist treatment longer show promise of reducing criminal justice involvement over time. Changes in sentencing policy may also be beneficial.