Substance Use Disorder and Long-Acting Injectable Antipsychotics: Predictors of Criminal Justice System Encounters Among People with Schizophrenia

Background: People with schizophrenia (PWS) face a substantial risk of criminal justice system (CJS) encounters. Understanding PWS's behavior that attracts CJS's attention, and the role substance use disorder (SUD) and long-acting injectable (LAI) antipsychotics treatment play on the risk is critical to prevent the vicious cycle of CJS encounters.Methods: PWS (N=976) who received services at the Community mental health centers in Summit County, Ohio, from 2010-2017, were included. Offenses from their first CJS encounters through 2018 were characterized. The role of SUD on the risk of CJS encounters was assessed using the time-to-event analysis. Rates of CJS encounters were compared between first-generation antipsychotics LAI (FGA-LAI) and second-generation antipsychotics LAI (SGA-LAI), across LAI antipsychotics, and treatment and non-treatment periods fitting Poisson regression models. For the former two comparisons, separate models were fitted for PWS with and without prior CJS encounters and PWS with and without SUD. Results: About 51% had > 1 encounter (median: 4.5) during 32.22 years of median follow-up. PWS were booked for an array of offenses and the most common were non-violent related to public disorder (23.28%), court order (17.45%), property (12.74%), and substance (11.07%). Two-fifth of the study sample had SUD (40%). Compared to the no SUD group, the hazards of getting CJS encounters were 1.88 and 1.83 for those with 1 (21.09%) and > 2 SUD (18.99%), respectively. Alcohol-alone (HR: 2.90), other single drug-alone (HR: 2.82), and polysubstance (HR: 1.91) use disorders had a significant negative effect on time-to-first CJS encounters. SGA-LAI vs. FGA-LAI treatment groups comparison showed no significant differences in the rates of CJS encounters. However, specific LAI comparison showed higher encounter rates among the risperidone treatment group compared to the PP1M group among those with prior CJS encounters (RR: 2.14) and SUD (RR: 1.95). PWS during treatment had at least a 31% lower rate of CJS encounters than during the non-treatment period. Conclusion: PWS attract law enforcement attention primarily for non-violent crimes. Having SUD increases their risk of CJS encounters. Maintaining continual treatment with LAI antipsychotics may be beneficial to reduce CJS encounters.