Access to and predictors of substance use treatment and support among people experiencing incarceration in the United States: Analysis of a national cross-sectional study

Substance use-related overdose continues to be one of the leading causes of preventable death in the U.S. People returning from prisons and jails are at heightened risk. Certain substance use treatment methods in carceral facilities - especially medication for opioid use disorder (MOUD) - have shown promise in reducing overdose rates. Treatment availability has been under-studied, with past research often measuring whether facilities offer treatment, but not whether individuals actually receive it. This study used individual-level data to characterize who qualifies for prison-based treatment, who receives it, and what factors affect one's likelihood of being treated, drawing from the most recent nationally-representative U.S. Survey of Prison Inmates. Descriptive statistics indicate that people with substance use disorder (SUD) who entered American prisons from 2014 to 2016 had lower levels of educational attainment, employment and housing, and higher levels of physical and mental illness. Just 13 % of individuals with SUD received any form of substance use treatment in prison; pharmacotherapies like methadone were almost nonexistent (<1 %). In controlled analysis, individuals who self-identified as Non-Hispanic Black or Hispanic had lower odds of receiving any treatment or support compared to Non-Hispanic White individuals. People convicted of a violent offense had lower odds of treatment than those convicted of other classes of crimes. These novel findings indicate that, in 2016, America's prison-based substance use treatment had both poor accessibility and inequitable distribution. This raises concerns that, even as facility-level availability of modalities like MOUD continues to expand, certain groups may be left out without attention to individual-level availability.