Imprisonment, Opioids and Health Care Reform: The Failure to Reach a High-Risk Population

• In Event: 2161 - Health, Inequality, and the Affordable Care Act

Abstract

We estimate the association between incarceration and receipt of needed health care in early adulthood and then analyze the mediation of this relationship by economic and health risks associated with opioid use after implementation of the Affordable Care Act [ACA].
We use survey adjusted multivariate logistic regression with the National Longitudinal Study of Adolescent and Adult Health (Add Health) before and after implementation of ACA, controlling for measured and unmeasured sources of heterogeneity. The negative influence among young adults of having been incarcerated on receiving needed health care after ACA is mediated through four hypothesized explanatory variables - un-prescribed opioid use (OR=.57; 95%CI=.37, .88), economic problems (OR=.56; 95%CI=.43, .72), health status (OR=1.64; 95%CI=1.41, 1.90), and health Insurance (OR=2.61; 95%CI=1.60, 4.26) – which account for nearly three quarters (71%) of the influence of having been incarcerated. As the U.S. is a leading industrialized nation in drug abuse and incarceration, we conclude that to overcome avoidance of treatment for opioid and other forms of drug abuse among young adults, health insurance reforms need to more proactively address economic and mental and physical problems related to opioid self-medication and associated with incarceration.

Authors

• John Hagan, Northwestern University

• Holly Foster, Texas A&M University