Justice involvement patterns, overdose experiences, and naloxone knowledge among men and women in criminal justice diversion addiction treatment

Harm Reduct J. 2019 Jul 16;16(1):46. doi: 10.1186/s12954-019-0317-3.


Background: Persons in addiction treatment are likely to experience and/or witness drug overdoses following treatment and thus could benefit from overdose education and naloxone distribution (OEND) programs. Diverting individuals from the criminal justice system to addiction treatment represents one treatment engagement pathway, yet OEND needs among these individuals have not been fully described.

Methods: We characterized justice involvement patterns among 514 people who use opioids (PWUO) participating in a criminal justice diversion addiction treatment program during 2014-2016 using a gender-stratified latent class analysis. We described prevalence and correlates of naloxone knowledge using quasi-Poisson regression models with robust standard errors.

Results: Only 56% of participants correctly identified naloxone as an opioid overdose treatment despite that 68% had experienced an overdose and 79% had witnessed another person overdose. We identified two latent justice involvement classes: low involvement (20.3% of men, 46.5% of women), characterized by older age at first arrest, more past-year arrests, and less time incarcerated; and high involvement (79.7% of men, 53.5% of women), characterized by younger age at first arrest and more lifetime arrests and time incarcerated. Justice involvement was not associated with naloxone knowledge. Male participants who had personally overdosed more commonly identified naloxone as an overdose treatment after adjustment for age, race, education level, housing status, heroin use, and injection drug use (prevalence ratio [95% confidence interval]: men 1.5 [1.1-2.0]).

Conclusions: All PWUO in criminal justice diversion programs could benefit from OEND given the high propensity to experience and witness overdoses and low naloxone knowledge across justice involvement backgrounds and genders.

Keywords: Addiction treatment; Criminal justice system involvement; Latent class analysis; Naloxone; Opioids; Overdose.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alcoholism / rehabilitation*
  • Clinical Competence*
  • Correlation of Data
  • Criminal Law / legislation & jurisprudence*
  • Cross-Sectional Studies
  • Drug Overdose / mortality
  • Drug Overdose / rehabilitation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Naloxone / therapeutic use*
  • Narcotic-Related Disorders / rehabilitation*
  • Sex Factors
  • Survival Rate
  • United States


  • Naloxone