Overall and substance use-specific healthcare utilization among individuals with and without criminal justice involvement in Ontario, Canada

PURPOSE: Correctional populations have higher rates of substance use disorders and related healthcare visits relative to the general population. However, limited evidence on substance use-related healthcare visits exists among this population. Using population data for Ontario, Canada, this study aims to examine overall and substance use-specific healthcare visits for individuals with and without known provincial criminal justice system involvement (CJI versus non-CJI, respectively). DESIGN/METHODOLOGY/APPROACH: This retrospective study compared overall and substance use-related healthcare visits between April 1, 2015 and March 31, 2020 among provincially-incarcerated individuals (CJI group) versus those without criminal justice involvement (non-CJI group). Both groups were identified through available health administrative data and were individually matched by age, sex and material deprivation. FINDINGS: The authors identified and matched 208,188 individuals (59.9% male) with and without CJI and a healthcare visit. Compared to the non-CJI group, those with CJI had approximately 20 times the rate of healthcare visits for alcohol use, drug use and illicit drug-related overdoses. Among those with CJI, females had a higher prevalence of overall healthcare visits, whereas males had a higher prevalence of substance use-specific visits. RESEARCH LIMITATIONS/IMPLICATIONS: Findings highlight the high number of healthcare visits for substance use-related needs among individuals with CJI in Ontario. These results can inform efforts to enhance correctional release planning, improve access to community-based treatment and strengthen substance use prevention and treatment interventions for this high-risk population. PRACTICAL IMPLICATIONS: Results can inform efforts to enhance correctional release planning, improve access to community-based treatment, and strengthen substance use prevention and treatment interventions for this high-risk population. ORIGINALITY/VALUE: To the best of the authors' knowledge, this study is the first in Canada to draw on population-level administrative health data to identify and match a large sample of individuals with and without CJI and examine substance use-specific healthcare utilization, longitudinally.