Screening Incarcerated Women for Opioid Use Disorder

• Published date: 01 January 2024
• DOI: http://doi.org/10.1177/00220426231151595
• Author: Michele Staton,Martha Tillson,Mary M. Levi,Matthew Webster,Carrie Oser,Carl Leukefeld
• Date: 01 January 2024
• Subject Matter: Articles

Article

Journal of Drug Issues

2024, Vol. 54(1) 57–73

© The Author(s) 2023

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DOI: 10.1177/00220426231151595

journals.sagepub.com/home/jod

Screening Incarcerated Women

for Opioid Use Disorder

Michele Staton

1

, Martha Tillson

2,3

, Mary M. Levi

4

,

Matthew Webster

1

, Carrie Oser

5

, and Carl Leukefeld

1

Abstract

The overall aim of the present study is to examine the utility of the DSM OUD Checklist and the

NM-ASSIST screening tools to identify symptoms consistent with OUD among incarcerated

women in county jails. This study contributes to the existing literature because research on

screening and assessment approaches for incarcerated women has been limited. The focus of the

current study is to describe the screening procedures and study recruitment for a larger parent

study focused on increasing treatment linkages. Study f‌indings indicate a positive correlat ion

between indicators of OUD using the two screening tools, as well as a high degree of correlation

between street opioid misuse and other high-risk drug indicators (overdose and injection

practices). These f‌indings underscore the importance of outreach, screening, and intervention in

real-world settings, including jails, in order to increase access to OUD treatment among this

vulnerable sample of women.

Keywords

OUD screening, justice-involved women, treatment

Introduction

Recent U.S.data indicate that the number of incarcerated women in 2020 was nearly f‌ive times the

number of incarcerated women in 1980 (The Sentencing Project, 2022). From 1980 to 2020, the

number of incarcerated women increased by about 475%, a rate nearly twice that of male in-

carceration. The high rate of incarceration for women is largely driven by drug-related charges,

which have increased 216% for women in the past 35 years (Herring, 2020). This trend is

1

Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA

2

Department of Sociology, College of Arts & Sciences, University of Kentucky, Lexington, KY, USA

3

Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA

4

Department of Psychology, College of Arts & Sciences, University of Kentucky, Lexington, KY, USA

5

Faculty Aff‌iliate, Center for Health Equity Transformation, Center onDrug and Alcohol Research, University of Kentucky,

Lexington, KY, USA

Corresponding Author:

Michele Staton, Department of Behavioral Science, College of Medicine, University of Kentucky, 1100 Veterans Drive,

Lexington, KY 40536-0086, USA.

Email: mstaton@uky.edu

consistent in Kentucky which ranks sixth in the nation for the highest rate of female incarceration

(The Sentencing Project, 2022), primarily attributed to the opioid epidemic (Cheves, 2017).

Kentucky is an epicenter of the opioid crisis, and despite a number of policy changes in the last

decade to curtail illicit distribution and misuse of prescription opioids, nearly 2000 Kentuckians

died of an overdose in 2020 –a 49% increase over 2019 (Kentucky Off‌ice of Drug Control Policy

[KYODCP], 2021). The drug overdose death rate in Kentucky is 57% higher than the national

average (National Center for Drug Abuse Statistics [NCDAS], 2022), and death rates for

Kentucky women (28.1%) are also considerably higher than the national average (14.4%; Akers &

Ward, 2018). Amid the opioid crisis, the criminal justice system, both in Kentucky and nationally,

has experienced tremendous growth and depleted resources due to opioid-related arrests

(Caulkins, Gould, Pardo, Reuter, & Stein, 2020). Justice-involved individuals have signif‌icantly

higher rates of opioid use disorder (OUD) than individuals in the general population (8.5% vs.

.8%; Substance Abuse and Mental Health Services Administration [SAMHSA], 2017). One study

found that the likelihood of justice system involvement increases along a continuum of opioid use

severity (Winkelman, Chang, & Binswanger, 2018). Incarceration signif‌icantly increases the risk

for opioid overdose deaths due to loss of tolerance, limited access to medications to treat OUD,

and disruptions to social support networks (Joudrey et al., 2019;Sinkman & Dorchak, 2022).

Considering these risks for justice-involved individuals in general, it is critical to focus research

efforts on OUD screening among incarcerated women. The opioid overdose death rate among

women increased 492% from 1999 (2.6/100,000) to 2017 (15.5/100,000; VanHouten, Rudd,

Ballesteros, & Mack, 2019). During this time, the most dramatic increases in opioid overdose

deaths among women were attributed to synthetic opioids (1643% increase), heroin (915%

increase), and prescription opioids (485% increase). Data from national samples have indicated

that a greater percentage of women demonstrate a need for opioid treatment compared to men, yet

fewer receive it (Martin, Parlier-Ahmad, Beck, Scialli, & Terplan, 2021). Women have been

signif‌icantly affected by the opioid crisis due in large part to self-medication, often related to

experiences of chronic pain (Goetz, Becker, & Mazure, 2021), physician prescribing practices and

self-medication (Mazure & Fiellin, 2018;McHugh et al., 2013), as well as a faster trajectory from

opioid exposure to the development of OUD (Greenf‌ield, Back, Lawson, & Brady, 2010;Kay,

Taylor, Barthwell, Wichelecki, & Leopold, 2010).

U.S. jail data indicate that 72% of incarcerated women met diagnostic criteria for substance use

disorder (compared to 62% of men), and 60% reported active drug use in the month before arrest

(compared to 54% of men; Bronson, Stroop, Zimmer, & Berzofsky, 2017). One study found that

97% of women randomly selected from three Kentucky jails reported illicit drug use, prim arily

opioids, in the year before incarceration (Staton et al., 2018). Treatment opportunities (including

medications to treat opioid use disorder) are limited in correctional settings, particularly jails,

despite the growing evidence base in recent years on sustaining recovery (Moore et al., 2019) and

reducing the risk of overdose (Malta et al., 2019) following release from custody. Yet,women with

OUD often attain and sustain sobriety during periods of incarceration but, in the absence of

effective treatment, there is substantial risk for relapse and overdose during community re-entry.

Thus, there is signif‌icant need to increase research on screening and assessment for OUD among

incarcerated women in order to more effectively target treatment during incarceration, as well as

during the transition to the community.

OUD treatment during re-entry is critical considering the risk for relapse and overdose fol-

lowing a long period of abstinence during incarceration (Binswanger, Blatchford, Mueller, &

Stern, 2013). In addition to overdose risk, women with OUD experience a number of health and

social challenges including high-risk pregnancies and fertility complications (Corsi & Murphy,

2021;Pentecost, Latendresse, & Smid, 2021), mental health issues including depression and

PTSD (McHugh et al., 2013), and higher rates of interpersonal conf‌licts and intimate partner

58 Journal of Drug Issues 54(1)