Prevalence and correlates of drug use during incarceration among people with opioid use disorder: A focused decision tree analysis.

INTRODUCTION

Substance use disorder is prevalent among incarcerated populations. However, gaps remain in the literature regarding the prevalence of incarcerated drug use and the factors associated with this behavior. This study explores the correlates of incarcerated drug use among individuals recently released from incarceration.

METHODS

We used data from the multi-site TCN PATHS study, a hybrid type-1 trial, which recruited people with OUD just prior or immediately following release from incarceration. At baseline, participants reported incarcerated drug use, past criminal legal involvement, drug use behaviors, and medical history. We used bivariate analyses and a Classification and Regression Tree (CART) model to determine factors associated with drug use during incarceration.

RESULTS

Approximately 17 % of the study population reported using drugs while incarcerated. The majority were male (89 %), White (45 %), straight (97 %), and had a high school education or equivalent (44 %). Participants who reported using drugs while incarcerated mostly used opioids and also reported experiencing withdrawal and social and work disruptions. We found that carceral context was a strong predictor for incarcerated drug use, specifically facilities with medium-to-high security levels and offering multiple types of MOUD were strong correlated of drug use during incarceration.

DISCUSSION: Given that carceral context was a strong predictor of incarcerated drug use, efforts to improve MOUD access and tailor treatment plans within facilities may help mitigate risk. Understanding the correlates of drug use in carceral settings will guide implementation of programs and policies tailored that improve the health of people who use drugs during incarceration.