The costs of crime during and after publicly-funded treatment for opioid use disorders: a population-level study for the state of California (original) (raw)
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Addiction, 2012
Aims This study investigates changes in criminal involvement among patients in opioid maintenance treatment (OMT) over a 7-year period prior to, during and after treatment, particularly in relation to differences in treatment engagement. Design, setting and participants Treatment data on all patients who started OMT in Norway between 1997 and 2003 (n = 3221) were cross-linked with national criminal records. The period of observation was divided into four phases; pre-treatment, in-treatment, between treatments and post-treatment. Findings During OMT, rates of criminal convictions for the cohort were reduced to fewer than half of waiting-list levels [incidence rate (IR) 0.63 versus 1.57]. Patients in continuous treatment had the fewest convictions (IR 0.47) during treatment. The highest rates were found among patients out of treatment after several treatment episodes (IR 1.52). All groups had significantly fewer criminal convictions during treatment compared to before treatment. Staying in OMT for 2 years or more was associated with significantly reduced rates of convictions during treatment. Younger age and pre-treatment criminal convictions were associated with significantly (P < 0.001) more convictions during treatment. Those who left treatment, permanently or temporarily, relapsed into high levels of convictions outside treatment.
Drug and Alcohol Dependence, 2012
I 1 The general term opioids refers to naturally-derived opiates from the opium poppy (morphine and codeine), semi-synthetic derivatives (heroin and buprenorphine) and fully synthetic opioids (methadone and phentanyl). The substances included in the category of opioids are referred to in the general statistics by United Nations Office on Drugs and Crime, UNOCD, and the European Monitoring centre for Drugs and Drug Addiction, EMCDDA. 2 Problem opioid use refers to 'injecting drug use or long duration or regular use of opioids' (EMCDDA, 2014).
Cost of drug use and criminal involvement before and during methadone treatment
Journal of Clinical Forensic Medicine, 1999
Aims: To examine criminal behaviour in methadone clients as a function of expenditure on illicit drugs. To quantify the benefit of treatment for this group and to identify individuals who do not reduce criminal behaviour or substance use as a consequence of treatment, Design: Cross-sectional examination of key methadone-treatment variables (age, methadone dose and length of time in treatment), and self-reported levels of spending on illicit drugs before and during methadone treatment.
Prescription Drug Monitoring Programs, Opioid Abuse, and Crime
2018
for helpful comments and suggestions. Dave acknowledges funding support from the Agency for Healthcare Research and Quality (AHRQ) (1 R03 HS025014-01). The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.
BMC psychiatry, 2013
Opioid maintenance treatment (OMT) is associated with reduced crime among heroin users, but little is known about how crime changes during different phases of treatment. The aim of this study was to investigate changes in criminal convictions on a day-to-day basis before and after entry or discharge from OMT. National cohort study of all patients (n = 3221) in OMT in Norway 1997-2003. Patients were followed over a 9-year period, before, during, and after treatment. Criminal convictions were studied on a day-to-day basis in relation to treatment status. A time-continuous estimate of the probability of convictions within the population for all days during observation was calculated. Changes in convictions were evident before changes of treatment status. During the 3 years prior to OMT, the convictions rate was approximately 0.4% per day. Prior to OMT, convictions decreased to about 0.2% per day on the day of treatment initiation. During the weeks before dropping out of treatment, conv...
Drug Treatment as a Crime Fighting Tool
2002
The primary approach to reducing crime in the US has been through the criminal justice system. However, drug treatment may be an effective tool in reducing crime. In order to make better use of treatment as an alternative approach, one needs to know if reducing drug use through treatment results in decreased crime. Aims of the Study: The objective of this paper is to model and empirically investigate the extent to which a change in drug use that results from treatment reduces crime and whether a change in drug use is causally related to change in crime. We focus on crime-forprofit. Methods: We use a multi-site dataset of 3,502 inner-city drug users entering treatment. We analyze the change in drug use and crime pre and post treatment. We take first differences to address the omitted variable problem. Results: We find that treatment reduces drug use and that, in turn, reduced drug use has a significant impact on crime. For our study population, reduced drug use seems to be causally related to reduced crime. This finding is robust to specification and subsamples. We estimate that reduced drug use due to treatment is associated with 54% fewer days of crime for profit, ceteris paribus. Discussion: We use a longitudinal data set and a novel approach to analyze the relationship between crime and drugs. We analyze a low-income, inner-city, drug-addicted sample. We use self-reported crime. For our purposes, the use of individual data is an improvement over the use of aggregate level data that has been used in much of the related literature. Limitations of our paper include that we do not have a random sample and that our measure is self-reported in the previous 30 days. Implications for Health Policies: Our findings suggest that drug treatment may be an effective crime-fighting tool. Treatment reduces not only the crime of drug possession, but also crime-for-profit. Current public policy emphasizes use of the criminal justice system, incarceration in particular, as a mechanism to combat crime. Given the huge and growing expense of the criminal justice system, drug treatment might be cost-effective relative to incarceration. California's so called "Proposition 36" is based on this yet to be proven premise. Although additional research is required, our findings may help inform the debate on treatment versus criminal justice. We have provided empirically-based findings that reduced drug use due to treatment can result in important reductions in crime. Our findings can serve as a building block for policy development.
Cost Variation among Subpopulations of Diverted Drug Offenders under California’s Proposition 36
Journal of Alcoholism & Drug Dependence, 2014
Objectives: To explore differences in government costs among several subpopulations of offenders who were eligible to participate in California's Proposition 36, enacted as the Substance Abuse and Crime Prevention Act of 2000 (SACPA). Methods: The study compared a time-lagged cohort of offenders meeting SACPA eligibility criteria before SACPA was enacted (N=42,706) to the first-year SACPA cohort (N=37,991). Difference-indifferences (DID), multilevel, multivariate, random-effects regression models that included membership in the subpopulation categories (criminal, mental health, employment) and interaction terms were estimated separately for men and women to determine the effect of SACPA on total costs and across eight cost domains (prison, jail, probation, parole, health, arrests, convictions, and treatment). Results: A substantial proportion of SACPA participants had significant chronic problems. SACPA-eligible male offenders with extensive criminal histories yielded greater DID savings than low-history offenders, an effect augmented by SACPA participation. Among female offenders with extensive criminal histories, overall savings were negated by increased arrest/conviction costs. A documented history of mental illness resulted in increased costs for men and women. Conclusions and implications for practice: SACPA participation was cost-effective among more severe cases, especially for male offenders with extensive criminal histories; however, the program did not attenuate increased costs for offenders with severe mental illness. Services for the special needs of such offender populations need further development and implementation.
The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017
Drug and Alcohol Dependence, 2021
Background:The United States (U.S.) is experiencing an ongoing opioid crisis. Economic burden estimates that describe the impact of the crisis are needed when considering federal and state resources devoted to addressing overdoses. In this study, we estimate the societal costs for opioid use disorder and fatal overdose from all opioids in 2017.Methods:We estimated costs of fatal overdose from all opioids and opioid use disorder based on the incidence of overdose deaths and the prevalence of past-year opioid use disorder for 2017. Incidence of fatal opioid overdose was obtained from the National Vital Statistics System; prevalence of past-year opioid use disorder was estimated from the National Survey of Drug Use and Health. Costs were estimated for health care, criminal justice and lost productivity. Costs for the reduced quality of life for opioid use disorder and life lost due to fatal opioid overdose were valued using U.S. Department of Health and Human Services guidelines for valuing reductions in morbidity and mortality.Results:Costs for opioid use disorder and fatal opioid overdose in 2017 were estimated to be $1.02 trillion. The majority of the economic burden is due to reduced quality of life from opioid use disorder and the value of life lost due to fatal opioid overdose.Conclusions:These estimates can assist decision makers in understanding the magnitude of opioid use disorder and fatal overdose. Knowing the magnitude and distribution of the economic burden can inform public policy, clinical practice, research, and prevention and response activities.