Everyday discrimination and daily illicit drug use among Kentucky adults with a history of opioid use disorder and incarceration

Background: Discrimination is disproportionately experienced by people exposed to the criminal-legal system (CLS) with opioid use disorder (OUD). Objectives: To examine the prevalence of discrimination by attribution (gender, race, substance use, history of medications for treatment of SUDs, and incarceration) and daily illicit drug use among a sample of CLS-involved adults treated for OUD. Methods: We used data from an ongoing longitudinal cohort of Kentucky CLS-involved adults with OUD (n = 367) and defined everyday discrimination as a continuous measure and included five attribution variables. We estimated associations with pre-incarceration daily drug use (cannabis, cocaine, prescription stimulants, methamphetamine, sedatives/sleeping pills, street opioids, and prescription opioids) using modified Poisson regression with robust standard errors to estimate prevalence ratios. Results: Most respondents (93.2%) reported discrimination before incarceration (mean: 2.1, SD: 1.3). Daily illicit drug use was most common for methamphetamine (63.2%), cannabis (49.9%), and street opioids (49.3%). Discrimination attributed to substance use history was associated with higher daily methamphetamine (86.2% vs. 74.8%, p < .01), sedative/sleeping pill (89.1% vs. 79.6%, p < .05), and opioid use (88.2% vs. 77.6%, p < .001), while discrimination attributed to medication for SUD treatment was associated with higher daily sedative/sleeping pill (40.2% vs. 28.0%, p < .05) and street opioid use (37.0% vs. 25.3%, p < .05). Discrimination frequency was associated with greater prevalence of daily (vs. non-daily) prescription opioid use (APR = 1.10, 95% CI: 1.01–1.20, p < .05). Conclusions: Discrimination was common among CLS-involved adults with OUD, with substance use and incarceration history identified as reasons for discrimination. These findings highlight salient sources of discrimination during the pre-incarceration period.