Understanding Fentanyl and Opioid Addiction in the Criminal Justice System

Overview of Opioid Addiction in the Criminal Justice System 

Opioid use disorders are very common among people in the criminal justice system. About half of state and federal prisoners meet the criteria for a substance use disorder (SUD), according to data from the United States Department of Justice.

The use of methadone, buprenorphine and naltrexone has been resisted in the criminal justice system and as a result, opioid use disorder goes largely untreated while in prison and use often returns upon release.

Overdoses are more common when a person relapses to drug use after a period of abstinence due to loss of tolerance to the drug. A former inmate’s risk of death within the first two weeks of release is more than 12 times higher than that of other individuals.

Untreated opioid use disorders also contribute to a return to criminal activity, reincarceration and risky behavior that contribute to the spread of HIV and Hepatitis B and C. One study found a reduction in post-incarceration deaths from overdose among individuals who had received medication for opioid use disorder in correctional facilities.

What is Fentanyl?

Fentanyl is a completely synthetic opioid that is 50 to 100 times more potent than morphine. Fentanyl can be prescribed to treat pain. Although there are instances of non-medical misuse of pharmaceutical fentanyl, the majority of the opioid overdose crisis in recent years has involved illicitly manufactured fentanyl.

Prescription fentanyl can be administered as an injectable solution, transdermal patch or lozenge. Synthetic opioids, including fentanyl, are the most frequently cited types of drugs involved in overdose deaths in the United States. The illicit forms of this drug are sometimes sold as powder or pressed into pills that resemble prescription medications. 

 What are the Forms of Fentanyl and How is it Used? 

When prescribed by a doctor, fentanyl can be given as a shot, a patch that is put on the skin or cough drop-like lozenges. It is also used to treat patients with chronic pain who are physically tolerant to other opioids.

Tolerance occurs when you require a higher and/or more frequent dosage of a drug to achieve the desired effects. Like morphine, it is typically used to treat patients with severe pain, particularly after surgery. Fentanyl is sold under the brand names Actiq, Duragesic and Sublimaze when it is prescribed.

The illegally used form that is most frequently linked to recent overdoses is made in labs and sold as powder, blotter paper, eye drops, nasal sprays and pills.

Fentanyl is being mixed with heroin, cocaine, methamphetamine and MDMA by many drug dealers recently. This is because it only takes a small amount of fentanyl to get high, making it cheaper for the dealers. This has a major impact on the number of overdose cases.

Factors Contributing to Opioid Addiction in the Criminal Justice System

Biological Factors 

Opioid use disorder (OUD) can also be predisposed to a person by a combination of genetic and biological factors. Genetic factors that alter the opioid receptors in the brain are factors that influence the effects of opioids, in addition to the biological vulnerability to substance use disorders in general.

When a person develops physiological tolerance to an opioid, they will experience withdrawal symptoms if they take less of the drug or stop taking it. In most cases one shifts from using to manage pain or for the high to using to avoid getting sick from withdraw. 

All aspects of opioid use and misuse can be influenced by individual factors, such as the likelihood of being exposed to opioids, the initiation of opioid misuse, the development and maintenance of opioid use disorder, entry to and participation in treatment and relapse following an attempt to quit. 

Social Factors 

There are various risk factors for developing an opioid addiction which include a personal or family history of substance use or addiction, a history of sexual abuse as a child and a history of mental health issues.

Opioid misuse is influenced by a wide range of sociodemographic factors, which have implications for identifying populations at risk.

Addiction to opioids tend to peak in early adulthood, between the ages of 18 and 25. Adolescence and young adulthood are important risk periods for misuse because early opioid misuse is a significant risk factor for OUD.

Addiction risk can also be influenced by gender. For instance, differences in the pharmacological effects of opioids have been demonstrated to show that women are more likely than men to receive a prescription for opioids. 

Effects of Opioid Addiction on Individuals and Communities in the Criminal Justice System 

What are the Effects on Physical Health?

Effects of fentanyl can include, but are not limited to, the following symptoms: 

• hallucinations or visual disturbances
• constipation or nausea
• trouble breathing
• rigidity in the muscles
• confusion, drowsiness or unconsciousness
• seizures
• overdose

The use of fentanyl can result in a wide range of negative effects, some of which are fatal. Opioids can cause dangerously slowed breathing and if left untreated, respiratory depression can progress to full respiratory arrest, or the complete shutdown of the respiratory system.

Fentanyl use is potentially even more risky for people who have issues such as asthma, liver failure, are hypersensitive to or allergic to certain fillers in fentanyl or have a low tolerance to opioids.

As a result, misuse of fentanyl can raise the risk of hypoxia, which is the reduced amount of oxygen reaching vital tissues, hypoxic brain injury and even death.

Opioid addiction can cause a variety of hard-to-reverse physical complications over time, such as poor nutrition and injectable drug abuse.

Long-term abuse of opioids results in the following physical effects:

• sleeplessness
• constipation
• stomach cramps
• sexual dysfunction

What are the Effects on Mental Health?

Mental illnesses, such as antisocial personality disorder and depression, affect many addicts. Addiction and depression have a bi-directional relationship, meaning that one disorder increases the likelihood of developing the other.

According to one study, 10% of opioid prescription patients will experience depression following treatment for pain (none had a previous depression diagnosis). Opioid-induced hormonal and dopamine interference may contribute to depression, according to recent research.

Some research also suggests that depression sufferers may be unable to fully experience the effects of some prescription opioids, necessitating higher dosages.

Depression and opioid addiction share some mental symptoms, including:

• changes in mood and increased irritability
• sleep patterns
• loss of appetite
• difficulty concentrating
• guilt or despair
• loss of interest in hobbies
• low energy
• thoughts of suicide

Addiction to opioids puts the brains of adolescents at even greater risk of negative mental effects. The brain grows until about the age of 25 and any damage it sustains during this time can slow or stop its development.

A 15-year-old’s brain can be permanently affected by damage to the white matter and prefrontal cortex, making it difficult for them to control their emotions, respond appropriately to stressful situations, and make sound decisions.

During brain development, it also has the potential to lower IQ levels. In addition, adolescents who begin using drugs earlier are more likely to develop addictions that last a lifetime, to overdose more frequently and to die earlier than those who begin using drugs later in life.

What are the Economic Effects?

It is difficult to quantify the impact of opioid addiction in terms of money. 

When weighing the impact of the opioid crisis on our economy, there are a number of things to take into account, including costs associated with substance abuse treatment, criminal justice and incarceration, the value of those whose lives have been lost as a result of opioid addiction, disability and workers’ compensation claims and productivity losses as a result of absenteeism and lower labor force participation.

Treatment Options for Opioid Addiction 

Opioid withdrawal, agonist maintenance and naltrexone treatment should all be available in prison settings and prisoners should not be forced to accept any particular treatment, according to the World Health Organization’s Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence.

Despite research demonstrating numerous benefits of incorporating medication-assisted treatment into criminal justice treatment programs, many states do not provide appropriate access to or use of medications to treat opioid use disorder among arrestees or inmates.

Those who receive methadone treatment and counseling in prison are more likely to enter community-based methadone treatment centers after their release (68.6 percent) than those who receive only counseling (7.8 percent) or who are in counseling and referred to a treatment center.

Inmates who receive buprenorphine treatment prior to release are more likely to engage in treatment after their release than inmates who only participate in counseling.

Withdrawal managed by medicine is usually the first treatment to try. The medical team keeps an eye on the patient to make sure that their withdrawal from fentanyl goes smoothly and safely.

People who are receiving treatment for opioid addiction (MAT) may be able to reduce their opioid use and maintain their recovery momentum with the assistance of medication.

Patients who receive treatment at an inpatient facility, where they will be cared for round-the-clock, have the best results. 

Outpatient treatment is ideal for people who struggle with co-occurring disorders as well as with relatively severe addictions and addiction-related issues. Mental health counseling helps people develop plans for preventing relapse and modifying maladaptive behaviors.

Compared to inmates who only receive counseling (62.9%), those who receive counseling and a referral to a treatment center (41%) and those who only receive counseling, methadone treatment and counseling participants in prison have a lower risk of testing positive for illicit opioids one month after release (27.6%).

A survey of community correction agents’ views on using medications to treat opioid use disorder showed that more favorable attitudes toward medication use are associated with greater knowledge about the evidence base for these medications and greater understanding of opioid use disorder as a medical disorder. 

Organizational linkage between correctional stakeholders and community treatment providers, along with training sessions, can be an effective way to change perceptions and increase knowledge about the efficacy of these medications and can increase the intent within correctional facilities to refer individuals with opioid use disorder to treatment that incorporates medications.

Get Help Today

If you or a loved one are struggling with fentanyl or opioid addiction, please get in touch with Luxe Recovery today. There are various treatment options which our knowledgeable admissions team can discuss with you.

Luxe Recovery offers a world class substance abuse and mental health treatment program to our clients as they make a commitment to overcome their addiction and live a fulfilling life of sobriety.