Court-Mandated Treatment Outcomes for Prescribed Opioid Use Disorder: A Gender Based Study

• Author: Viviana Ximena Lucabeche,Paul Victor Quinn
• Published date: 01 January 2022
• Date: 01 January 2022
• DOI: 10.1177/00220426211044410
• Subject Matter: Articles

Article

Journal of Drug Issues

2022, Vol. 52(1) 47–66

© The Author(s) 2021

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DOI: 10.1177/00220426211044410

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Court-Mandated Treatment

Outcomes for Prescribed

Opioid Use Disorder: A Gender

Based Study

Viviana Ximena Lucabeche

1

, and Paul Victor Quinn Sr.

2

Abstract

This study provides empirical information suggesting court-mandated treatment may be a more

effective treatment pathway for opioid use disorder (OUD). To examine the effects of mandated

treatment for prescription opioid users, we consider the differences in discharge complet ion rates

for court-mandated and non-mandated treatment for both males and females. We use the

Treatment Episode Data Set-Discharges (TEDS-D) from 2015 to 2017 with 13,239, 14,765, and

15,433 cases, respectively, to study successful completion rates for males and females with OUD.

Logistic regression analysis conf‌irms a greater completion rate for mandated treatment episodes.

Of all mandated females, 59% completed treatment in each of the 3 years as compared to the 59%,

65%, and 64% of successful completion for mandated males, respectively, from 2015 to 2017. Our

results suggest court-mandated treatment pathways are more effective on treatment completion

for individuals with OUD, yet treatment completion disparity between sexes increases even when

females are mandated.

Keywords

court mandated treatment, opioid use disorder, gender, treatment pathway

Introduction

According to the National Institute on Drug Abuse (2020), opioid overdoses cause up to 128

deaths per day. More than heroin and cocaine combined, prescription opioids contribute to 22,598

deaths by overdose making this a public health crisis (National Institute on Drug Abuse [NIDA],

2020). Dependency to prescription opioids and opiates transcends traditional drug treatment

approaches, requiring social, economic, and legal considerations for successful treatment out-

comes. In this study, we aim to show that individuals with opioid use disorder (OUD) who are

1

Bloomsburg University, Bloomsburg, PA, USA

2

Kutztown University, Kutztown, PA, USA

Corresponding Author:

Viviana Ximena Lucabeche, Bloomsburg University, 2119 McCormick Center, Bloomsburg, PA 17815, USA.

Email: viviana.lucabeche@gmail.com

court mandated to treatment are more likely to successfully complete the treatment process as

compared to those not mandated even when considering the alternative of incarceration or self-

referral. We posit court-mandated treatment may reduce fatalities due to the increased likelihood

of treatment completion which clinically relates to successful long-term outcomes (Marie, Sahker,

& Arndt, 2015). Results from data collected over a three-year period (2015, 2016, and 2017) from

Treatment Episode Data Set-Discharges (TEDS-D) suggest that the mode of referral, court

mandated, shows a high number of successful treatment completions for individuals with OUD.

Opioid Use Disorder

In accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria,

individuals with opioid use disorder will take more than the intended amount over a period of time,

require more of the drug for the desired effects, will not cease using the drug despite negative

consequences, and will experience craving in the absence of the drug. The compulsive char-

acteristics of opioid use disorder (OUD) involve a destructive pattern of use that have a biological

base affecting the brain and the body (Heyman, 2013); it follows that without intervention, the

mortality risk increases.

The Center for Disease Control (CDC) reports the United States is the largest consumer of

prescribed opioids estimating 82.5 prescriptions per 100 people (2017). While we consider the

increase of medical access to prescribed opioids coupled with the pharmaceutical promotion of

opioids, eventually the highly addictive nature of this drug leads to non-medical use (Powell,

Pacula, & Taylor, 2020). Due to the lack of empirical evidence, it is diff‌icult to ascertain how the

extent of the intended medical use overlaps with the non-medical, problematic abuse of the drug.

However, continued misuse of prescribed opioids is a strong predictor of the eventual transition to

heroin (Rudd, Aleshire, Zibbell, & Gladden, 2016).

The United Sates faces a surge in deaths by overdose for individuals with OUD (Larochelle

et al., 2019). Individuals with OUD present with intrinsic treatment needs due to higher health

risks from the adverse effects of opioids, pose greater risk for overdose, suicide, and infectious

diseases such as human immunodef‌iciency virus (HIV) and hepatitis C (Madras, Ahmad, Wen, &

Sharfstein, 2020). Protective factors to prevent pre- and post-treatment adverse effects of OUD,

including overdose, best serve the treatment process when applied early. Individuals with criminal

justice involvement need collaboration between criminaljustice and community providers to access

early treatment interventions to ameliorate the risk of overdose and death (Grella et al., 2021).

Gender

OUD disproportionately affects subgroups, such as females, which are one of the most vulnerable

of these groups (Brinkley-Rubinstein et al., 2018). Although males participate slightly higher in

prescribed opioid use than females, the rate of incarceration for females with OUD is higher

(Longinaker & Terplan, 2014). Grella (2008) found that males referred to treatment by the

criminal justice system, experienced a higher level of support from family and their communities

than females. Although opioid use is almost the same for both sexes, females often present with

greater psychological stressors and experience poorer quality of life complicated by their sub-

stance use (Davis et al., 2021). These sex differences increase stigma for females which manifests

in the internalization of guilt and shame hindering successful treatment retention efforts (Howard,

2015).

Although, medication-assisted treatment for OUD is often the recommended treatment in-

tervention for OUD, our focus is court-mandated treatment across all treatment modalities

(hospitalized residential rehabilitation (non-detox); short-term (30 days or fewer) residential

48 Journal of Drug Issues 52(1)