Opioid Use and Overdose Among Justice-Involved Individuals: A Cross-Sectional Study of Social Determinants of Health.

Abstract

Justice-involved individuals with opioid use history face significant social determinants of health challenges that may influence recovery outcomes. This cross-sectional study examined the association between 24 demographic and social determinants of health variables and two outcomes: self-reported opioid use within 1 month and previous overdose. Participants (N = 255) were recently released from incarceration and enrolled in a peer-based recovery program. Bivariate analyses and exploratory logistic regression models were used to examine patterns of association. Peer meeting attendance was associated with a significantly lower likelihood of recent opioid use, suggesting a protective influence of social connection. In contrast, transportation insecurity and co-occurring mental health diagnoses were associated with increased odds of both opioid use and overdose, underscoring potential barriers to recovery. Other observed associations included younger age, race, health care access challenges, and parental status. Medications for opioid use disorder (MOUD) enrollment was also associated with prior overdose history, potentially reflecting more severe use patterns among individuals identified for treatment. Notably, financial insecurity was linked to reduced opioid use, and having children was associated with lower overdose risk, though these relationships may reflect short-term or contextual elements. These findings highlight the complex amalgam of social, health, and economic factors that may shape opioid use and overdose patterns in this population. For nurses in corrections and community health, understanding the cumulative effects of transportation, health care access, mental health, and social support is essential for improving engagement and promoting recovery outcomes.