"Convenience, Quickness, and Compassion": Experiences of People Involved in the Criminal-Legal System Accessing...

This study aimed to explore the experiences of people diagnosed with opioid use disorder (OUD) and recently involved with the criminal-legal system (CLS) as they received addiction treatment services from a Mobile Medications for Opioid Use Disorder (MOUD) programme in Chicago. By assessing perceptions and satisfaction with receiving addiction treatment and additional wraparound services, including factors influencing care-seeking decisions, this research provides insight to tailor care and services to this population of people who have involvement with the CLS. Insights from this population are critical to increasing their access to MOUD and other services, given that people with CLS involvement are at disproportionately higher risk of overdose than people without such involvement.

Semi-structured interviews were conducted with people with OUD engaged in mobile MOUD services who had CLS involvement in the past 90 days (arrested, booked, or charged; released from prison, jail, or electronic monitoring; or currently on probation, parole, or supervised release). Eligibility for participation was determined by an outreach specialist with knowledge of past service utilisation and access to the medical record. Questions were based on Consolidated Framework for Implementation Research (CFIR) domains. Interviews were recorded, transcribed, deidentified, and inductively analyzed using Dedoose qualitative analysis software. The primary phenomenon of interest was a description of perceived benefits, barriers, and facilitators to accessing mobile MOUD services by CLS-involved individuals.

A total of 13 interviews were conducted. The mean age of the participants was 48.5 years (SD 11.4). Over half of participants identified as Black or African American (61.5%) and male (61.5%). In the 30 days prior to interview, seven (53.8%) participants reported stable housing, five (38.5%) were living outdoors, and one (7.7%) had been incarcerated. Five themes and eight sub-themes were identified. Participants viewed the mobile unit services as essential to their communities, citing proximity to an open-air drug market and limited services in the area. Participants overwhelmingly praised the non-judgmental, approachable, and trustworthy environment compared to other healthcare settings. Law enforcement interactions ranged from positive to neutral, with some noting CLS referrals to mobile medical unit care. Key facilitators included onsite MOUD dispensing, walk-in appointments, and comprehensive medical services. Word-of-mouth, co-utilisation of mobile services with partners, friends, and/or family, and intrinsic self-motivation were identified as facilitators to mobile unit access. Barriers to accessing care included incarceration, transportation, and schedule/service awareness.

By exploring the perspectives of people with opioid use disorder and involvement with the CLS, the study contributes to the design and tailoring of an established mobile MOUD programme to meet their collective needs, including broader implementation of services that support re-entry to the community, like peer recovery and recovery-oriented support groups.

This study directly involved people with opioid use disorder who were recently involved in the criminal-legal system, a population historically marginalised in healthcare settings, enabling a client-informed approach to service improvement. By centreing their voices through qualitative interviews, the research provides insight into how structural barriers such as incarceration, housing instability, stigma, and limited service availability affect their ability to access treatment. Results from this qualitative study will be discussed with members of the Community Outreach Intervention Projects (COIP) organisation who have lived experience with substance use disorders and living experience with the neighbourhoods these services are offered in. The findings inform actionable strategies to adapt mobile healthcare services to better meet the unique needs of this population, including facilitating access immediately post-release.