Criminal Legal Referrals Were Associated With Delayed Substance Use Treatment, Disparity By Housing Status.

Timely access to substance use disorder (SUD) treatment is critical to improving health outcomes, yet treatment delays remain a barrier. Using national Treatment Episode Data Set-Admissions data from the period 2017-22, we conducted the first national study to examine the association of referral pathways and housing status with treatment delays among 962,702 first-time SUD admissions. Compared with individual referrals, criminal legal referrals were associated with more than twice the odds of delayed admission. This association differed by housing status and was strongest among people experiencing homelessness. These findings suggest that homelessness may intensify barriers to timely SUD treatment for people referred via criminal legal referral pathways. Our results are concerning in light of the 2025 executive order, "Ending Crime and Disorder on America's Streets," which emphasizes the use of civil commitment and institutionalization for people experiencing homelessness and people with SUD. To improve treatment retention and reduce substance use, policy efforts should prioritize removing administrative and legal barriers to SUD treatment. Low-threshold treatment models and treatment with low barriers to participation should be expanded.