The costs of crime during and after publicly funded treatment for opioid use disorders: a population-level study for the state of California

Background and aimsTreatment for opioid use disorders (OUD) reduces the risk of mortality and infectious disease transmission; however, opportunities to quantify the potential economic benefits of associated decreases in drug-related crime are scarce. This paper aimed to estimate the costs of crime during and after periods of engagement in publicly funded treatment for OUD to compare total costs of crime during a hypothetical 6-month period following initiation of opioid agonist treatment (OAT) versus detoxification. DesignRetrospective, administrative data-based cohort study with comprehensive information on drug treatment and criminal justice systems interactions. SettingPublicly funded drug treatment facilities in California, USA (2006-10). ParticipantsA total of 31659 individuals admitted for the first time to treatment for OUD, and who were linked with criminal justice and mortality data, were followed during a median 2.3years. Median age at first treatment admission was 32, 35.8% were women and 37.1% primarily used prescription opioids. MeasurementsDaily costs of crime (US$2014) were calculated from a societal perspective and were composed of the costs of policing, court, corrections and criminal victimization. We estimated the average marginal effect of treatment engagement in OAT or detoxification adjusting for potential fixed and time-varying confounders, including drug use and criminal justice system involvement prior to treatment initiation. FindingsDaily costs of crime during treatment compared with after treatment were $126 lower for OAT [95% confidence interval (CI)=$116, $136] and $144 lower for detoxification (95% CI=$135, $154). Summing the costs of crime during and after treatment over a hypothetical 6-month period using the observed median durations of OAT (161days) and detoxification (19days), we estimated that enrolling an individual in OAT as opposed to detoxification would save $17550 ($16840, $18383). ConclusionsIn publicly funded drug treatment facilities in California, USA, engagement in treatment for opioid use disorders is associated with lower costs of crime in the 6months following initiation of treatment, and the economic benefits were far greater for individuals receiving time-unlimited treatment.