Overdose and recidivism among people with criminal justice system involvement and substance use disorders: Identifying longitudinal trends during dual public health emergencies in British Columbia

People with criminal justice system involvement (e.g. incarceration, criminal charge or conviction) are more likely to use illicit substances (e.g. heroin, methamphetamine) compared to the general population. Those who do, are at higher risk of negative outcomes including overdose and more rapid and/or frequent return to custody. Efforts to address overdose, both in prisons and in the community, have been focused on treatment for people with opioid use disorder, by prescribing opioid agonist treatment. This alone may not be sufficient to reduce illicit opioid use, particularly among people who also use other substances. In March 2020, in the context of COVID-19, British Columbia's Ministry of Health took a significant step to expand access to prescription alternatives to the toxic drug supply and provided doctors with new guidelines and permissions for prescribing opioids, stimulants, benzodiazepines, and alcohol withdrawal management medications to people at risk of overdose. The goal of this study is to evaluate whether these guidelines, which account for coexisting substance use disorder diagnoses, are effective at reducing overdose and criminal justice system involvement. Provincial health and criminal justice records will be examined to identify how many people with and without criminal justice system involvement have substance use disorder diagnoses (and which type of diagnosis) in British Columbia. Trends of overdose and criminal justice system involvement will then be examined, to identify whether there were any changes after opioid agonist treatment expansion efforts, or after the new treatment guidelines introduced in March 2020. Findings will highlight gaps in substance use services in British Columbia, and will inform policies and services intended to reduce overdose in both criminal justice and community health systems.