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      Adverse effects of criminal legal system involvement: a qualitative study examining the role of incarceration and reentry on substance use trajectories among women with opioid use disorders

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          Abstract

          Background

          Women with substance use disorders (SUDs) often experience adversity related to incarceration and reentry that can impact their substance use outcomes. This study aims to examine the adverse effects of incarceration and reentry on substance use outcomes among women with a history of opioid use disorder (OUD).

          Methods

          We carried out 42 semi-structured interviews (May–July 2022) with women with a history of criminal legal involvement and OUD ( n = 20), criminal legal professionals ( n = 10), and SUD treatment professionals ( n = 12). The interviews focused on women’s substance use trajectories, barriers to treatment, and the intersection of the criminal legal system and treatment. None of the women were presently incarcerated during their interviews.

          Results

          Participants expressed the severe adverse impact of criminal legal involvement on women with OUD. Many women felt traumatized by experiencing detox while incarcerated, especially as they received minimal aid for withdrawal symptoms. Women seeking recovery while incarcerated felt unsupported, being afforded few treatment options, and experiencing stigma. Reentering society after incarceration also posed significant challenges to women’s individual recovery goals. Reentry-related challenges such as returning to unsupportive environments, facing difficulties finding employment, lacking secure housing, and facing the stigma of incarceration triggered adverse outcomes, such as relapse among those who were seeking to avoid illicit substances.

          Conclusions

          Findings suggest a need to evaluate detox protocols, medication for opioid use disorder (MOUD) access, and stigma in the criminal legal system. Interventions facilitating women’s reentry, reducing the combined stigma of incarceration and OUD, and restoring agency for women with OUD are also needed.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s44263-024-00058-1.

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          Most cited references57

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Release from prison--a high risk of death for former inmates.

            The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons. We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were linked to the National Death Index. Data for comparison with Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research system of the Centers for Disease Control and Prevention. Mortality rates among former inmates were compared with those among other state residents with the use of indirect standardization and adjustment for age, sex, and race. Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years. The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after release, the risk of death among former inmates was 12.7 (95% CI, 9.2 to 17.4) times that among other state residents, with a markedly elevated relative risk of death from drug overdose (129; 95% CI, 89 to 186). The leading causes of death among former inmates were drug overdose, cardiovascular disease, homicide, and suicide. Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison. Copyright 2007 Massachusetts Medical Society.
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              Mortality after prison release: opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009.

              Among former prisoners, a high rate of death has been documented in the early postrelease period, particularly from drug-related causes. Little is known about risk factors and trends in postrelease mortality in the past decade, especially given general population increases in overdose deaths from pharmaceutical opioids. To determine postrelease mortality between 1999 and 2009; cause-specific mortality rates; and whether sex, calendar year, and custody factors were risk factors for all-cause, overdose, and opioid-related deaths. Cohort study. Prison system of the Washington State Department of Corrections. 76 208 persons released from prison. Identities were linked probabilistically to the National Death Index to identify deaths and causes of death, and mortality rates were calculated. Cox proportional hazards regression estimated the effect of age, sex, race or ethnicity, whether the incarceration resulted from a violation of terms of the person's community supervision, length of incarceration, release type, and calendar year on the hazard ratio (HR) for death. The all-cause mortality rate was 737 per 100 000 person-years (95% CI, 708 to 766) (n = 2462 deaths). Opioids were involved in 14.8% of all deaths. Overdose was the leading cause of death (167 per 100 000 person-years [CI, 153 to 181]), and overdose deaths in former prisoners accounted for 8.3% of the overdose deaths among persons aged 15 to 84 years in Washington from 2000 to 2009. Women were at increased risk for overdose (HR, 1.38 [CI, 1.12 to 1.69]) and opioid-related deaths (HR, 1.39 [CI, 1.09 to 1.79]). The study was done in only 1 state. Innovation is needed to reduce the risk for overdose among former prisoners. National Institute on Drug Abuse and the Robert Wood Johnson Foundation.
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                Author and article information

                Contributors
                sqs6974@psu.edu
                Journal
                BMC Glob Public Health
                BMC Glob Public Health
                BMC Global and Public Health
                BioMed Central (London )
                2731-913X
                1 May 2024
                1 May 2024
                2024
                : 2
                : 26
                Affiliations
                [1 ]Department of Human Development and Family Studies, Pennsylvania State University, ( https://ror.org/04p491231) State College, PA 16801 USA
                [2 ]Department of Agricultural Economics, Sociology, and Education, Pennsylvania State University, ( https://ror.org/04p491231) State College, PA 16801 USA
                [3 ]Department of Sociology and Criminology, Pennsylvania State University, ( https://ror.org/04p491231) State College, PA 16801 USA
                Article
                58
                10.1186/s44263-024-00058-1
                11622996
                2a6381ce-65ec-4502-ab95-d99c5fa2feaf
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 23 October 2023
                : 3 April 2024
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: K01DA051715: PI, Jones A.A
                Award Recipient :
                Categories
                Research
                Custom metadata
                © BioMed Central Ltd. part of Springer Nature 2024

                women,criminal justice system,criminal legal system,substance use

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