Opioid treatment may reduce contact with law enforcement

(Reuters Health) – Opioid users who get treatment for their drug dependency are less likely to have police encounters or to be charged with crimes, an Australian study suggests.

Treatment – which can include methadone, buprenorphine or buprenorphine-naloxone – also delayed the time to a first criminal charge, particularly when users spent more continuous time in a treatment program. But the benefit of medication dwindled with time and when users dropped in and out of treatment, the study authors report in The Lancet Public Health.

“Contact with the criminal justice system – both in terms of crime and imprisonment – among opioid-dependent people is associated with a significant economic burden to society and has many negative impacts,” lead study author Natasa Gisev of the National Drug and Alcohol Research Center at the University of New South Wales in Sydney said by email.

Medications known as opioid agonists are among the most widely-used treatments for opioid dependence worldwide, according to the World Health Organization. Researchers have begun examining how treatment with opioid agonists may affect contact with the criminal justice system.

“Not all people who use heroin and other drugs commit crimes,” Gisev told Reuters Health. “In our study, 46% of people had no criminal convictions.”

Gisev and colleagues analyzed data for 10,744 opioid-dependent people who entered opioid agonist treatment (OAT) for the first time between 2004 and 2010 in New South Wales, where the therapy is provided for free at public clinics or correctional facilities or a small fee at private clinics and community pharmacies.

The study used three databases to track treatment episodes, deaths and criminal charges through December 2011.

Researchers found that 5,751, or 53.5%, of people enrolled in OAT were charged with a criminal offense during the follow-up period, and 49% were no longer enrolled in treatment one year after they had started. Getting treatment was associated with delaying the time to first charge.

But the charge-delaying effect diminished around the two-year mark after enrolling in treatment. The number of charges also increased as the number of treatment episodes increased. Men, younger enrollees under 25, and those who had more charges before entering treatment, were more likely to encounter law enforcement again.

Overall, those who spent more time in continuous treatment and follow-up programs had fewer charges.

“Although we have shown that OAT has important benefits in helping to reduce crime, it is also important to look at the context in which offending occurs,” Gisev said. “There are many reasons motivating an individual to offend, such as poverty, unemployment and social circumstances, and these also have to be considered in addressing the full scope of the issue.”

“Many people who get caught up in opioid dependence also get caught up in crime, as a means to get money for drugs,” said Tim Millar of the Center for Mental Health and Safety at the University of Manchester in the UK.

This study includes a large number of people, which is positive, and indicates that treatment is more helpful the longer that people enroll continuously, said Millar, who co-wrote an editorial accompanying the study. At the same time, it clarifies that the association between treatment and crime is not straightforward.

“Don’t be confused into thinking that OAT is a waste of time because ‘It is just substituting one drug for another,’” Millar said. “OAT saves lives, is a step towards rebuilding lives, and helps reduce the impact of opioid dependence on communities.”

SOURCE: bit.ly/2XIhSS0 and bit.ly/2XNDZ9w The Lancet Public Health, online June 11, 2019.