Opioids and the Justice-Involved: A ‘Mishandled’ Crisis

An estimated 65 percent of the United States prison population suffers from an active substance abuse disorder, and about 80 percent of people in jail or prison report using illicit substances in their lifetimes.

Yet research indicates that few incarcerated individuals receive evidence-based substance abuse disorder treatment—resulting in continued substance abuse post-incarceration.

The systems in place to provide addiction resources are falling short, largely due to a lack of interoperability between agencies responsible for overseeing successful recovery and rehabilitation of currently and post-incarcerated individuals.

Formerly incarcerated individuals are among those most vulnerable to substance abuse and relapse. To make matters worse, America is suffering from a widespread opioid crisis affecting individuals of all backgrounds and exacerbating substance abuse issues for the post-incarcerated population.

According to the U.S. Department of Health and Human Services, in 2019, an estimated 10.1 million people over the age of 12 misused opioids, with 9.7 million individuals abusing prescription pain relievers and 745,000 people using heroin and the Centers for Disease Control and Prevention (CDC) estimates that 93,331 people died from drug overdoses in 2020—a 30 percent increase from 2019.

The opioid crisis has become one of the most staggering and prominent issues across the U.S. It has created a need for recovery, rehabilitation and correctional agencies to have digital interoperability to provide better assistance and treatment to substance abusers and incarcerated individuals.

America’s drug laws create an inherent connection between these two populations, so substance abuse facilities and criminal justice institutions must work in lockstep.

The crisis is only getting worse.

There has been a 57 percent increase in fentanyl-related overdose deaths in Seattle, a 162 percent increase in Las Vegas, and opioid overdoses skyrocketing in California. San Francisco had a 61 percent increase in overdose deaths last year – amounting to 708 deaths.

In comparison, only 254 people died from COVID-19.

There is no effective interoperability system in place to ensure these agencies have immediate ways to communicate and update each other. Worse, there is also a lack of responsibility for who plays the overarching role of overseeing recovery. Too much finger-pointing occurs in post-incarceration care—at the expense of the substance user.

There is an urgent need for coordination, and by developing a common understanding of an individual’s situation, agencies can provide better treatment.

The mishandling of this public health crisis comes with an economic burden. In total, opioid misuse in the U.S. is estimated to cost $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. But the financial burden isn’t the only concern; agencies across the country are strained by an influx of patients, inmates, homeless and other individuals who desperately need help.

The new age of digital communication and technological advances provide some hope in ridding the agency communication gap that is causing avoidable deaths and overdoses.

A collaborative solution is required to both enhance connection amongst the agencies and provide an instant connection for individuals to reach out when they are around triggers. Increased interoperability among departments through the use of connected technology platforms can streamline communications and ensure essential information about vulnerable individuals is delivered to appropriate supervising agencies.

Rather than being left with few resources, little oversight and a significant delay in any actions taken by departments, technology solutions to agency interoperability ensure individuals struggling with addiction feel connected and supported in their journey to successful recovery.

At a time when the opioid crisis is hitting new highs, our country must focus on long-term solutions to improve agency interoperability and ultimately provide better, faster care for individuals struggling with addiction post-incarceration.

Unnecessary Delays Increase Chances for Relapse

Behavioral health agencies maintain one of the closest and most significant relationships with a person re-entering their community and beginning the rehabilitation process. Currently, if an individual is going through substance abuse treatment in an outpatient program and is required to provide a urinalysis each week, supervising officers might not learn of a relapse until 30 days later.

A lack of interoperability between the outpatient program and the corrections unit means that these essential updates are not shared in real-time. In turn, solutions are not implemented, and the recovery process is delayed. In the two weeks after their release, recently incarcerated people are almost 42 times more likely to die from an overdose than the general population. This time gap and delay in communication between agencies can be the make-or-break moment for a substance user.

Implementing technology such as care coordination platforms allows case managers to oversee the journey throughout the criminal justice process for an individual by determining if they are showing up for their appointments and fulfilling obligations for successful re-entry.

When interoperability is prioritized, these platforms allow behavioral health providers to update pertinent information to supervising officers—potentially stopping a budding relapse in its tracks. The use of application programming interfaces (APIs) to help the systems talk to each other allows common fields to be mapped out to display updated information immediately. This pushes the data back to a care coordinator platform and ensures that the supervising officer receives critical updates on their virtual dashboard instantly.

Closed Loop Referral Systems

 If an individual going through substance abuse treatment needs a referral to help them get a job, a closed loop referral system assists with resume building, finding resources for professional clothing, and guiding them through the hiring process.

Closed loop referral systems have computerized indexes of all the services in the geographic area. Rather than handing someone a piece of paper with a list of local resources, the agency can make a digital referral and push the application form to the individual to complete their application. This key digital connection breaks down the silos to access and speeds up the process to make it easier for the individual to apply for services. Further, the entity doing the referring can then receive notification that the individual engaged with the organization.

With closed loop referral systems, outcomes can be tracked, and behavioral health specialists or supervising officers can intervene if they notice their patient is not following through. In some parts of the country, states are beginning to adopt these more efficient and successful ways of providing referrals to individuals in substance abuse treatment.

For example, Arizona is implementing a state-wide closed loop referral system to “connect healthcare and community service providers to streamline the referral process, foster easier access to vital services and provide confirmation when social services are delivered.”

The state also joined forces with Colorado to exchange health information, connecting more than 1,300 healthcare providers to significantly increase interoperability between states.

Empower Individuals with Connected Mobile Apps

 Smartphones are an extension of ourselves and our connection to the world around us. Utilizing secure applications for substance abuse treatment that are connected to agencies and resources provides real-time assistance for individuals during the re-entry process.

This type of application can be a platform that not only delivers services; it encourages interaction. Similar to the psychological reward people feel for reaching 10,000 steps with a smart watch, secure smartphone applications for recovery and rehabilitation provide incentives for success and help individuals navigate more positive decision making.

When interoperability allows for supervising officers to see that an individual made it to their Narcotics Anonymous (NA) meeting on time, rewards can be provided. In contrast, if an officer notices someone missing meetings, they can more quickly address the issue and help individuals get back on track to successful recovery.

For substance users, avoiding triggering areas is essential to remaining on the road to recovery. Places such as known local areas to buy drugs, liquor stores or other triggers can be difficult to avoid during the rehabilitation process. Geofencing allows for the app to recognize dangerous areas, recommend alternate paths and alert supervising officers or behavioral health specialists if the individual chooses to enter the area despite warnings to exit.

It can also determine if an individual simply checked into an AA or NA meeting, or if they actually stayed for the entire time.

Michael Hirschman

Of course, no application is foolproof, but providing resources such as secure mobile apps that can track behaviors and deliver critical data to the agencies overseeing the individual can significantly increase the likelihood for successful recovery.

Additional Reading: Opioid Distributors Reach $26B Deal to Settle Lawsuits, The Crime Report, July 22, 2021

Michael Hirschman is the Founder and CEO of TRACKtech, a technology company focused on providing mobile solutions to the justice system, homelessness, addiction and more. His background in law enforcement and U.S. military intelligence provided the foundational ideas behind TRACKtech’s wrap-around service model – from entry to re-entry. Michael welcomes comments from readers.