Comparison of women offenders who use opioids versus other types of substances

Research Highlights: Women who use opioids were most likely to have a substantial to severe substance use issue.

Substance use issues are prevalent among federal women offenders.^{Footnote 1} Given the opioid crisis within Canada and the accompanying harmful effects, this study explored the differences between women who reported using opioids versus other substances in the twelve months prior arrest.

The Women’s Computerized Assessment for Substance Abuse (W-CASA) assesses federally sentenced women upon entering custody. In total, 908 women completed the W-CASA between November 2016 and January 2019. Of those assessed, 81% (n = 735, 40% Indigenous) indicated substance use in the 12 months prior to arrest and were grouped based on the substance used most: opioids, cocaine/crack, marijuana, alcohol, central nervous system (CNS) stimulants, CNS depressants, or other drug types.^{Footnote 2}

Women were most likely to indicate alcohol (26%), CNS stimulants (22%) and opioids (20%) as their substance of choice. Women in the opioid group were more likely to indicate that their substance use impacted on their criminal behaviour than the marijuana or alcohol groups (83% versus 55% and 38%), but were comparable to those in the other drug groups. However, women in the opioid group were more likely to be have a substantial to severe issue (84%) than the other substance types (see Figure).

Two-thirds (66%) of women who indicated opioid use reported injection drug use (IDU) compared to about half of the women who used cocaine/crack (50%), CNS stimulants (45%) or CNS depressants (45%). Women in the marijuana or alcohol groups were much less likely to indicate IDU (19% and 14%, respectively). Women in the opioid and cocaine/crack groups were most likely to also indicate sharing needles (26% and 28%, respectively, versus 6% to 19% in the other groups).

Overall, women in the opioid group were more likely than those in the other substance use categories to report same day polysubstance use (83% versus 23% to 80%) or prescription drug misuse (41% versus 5% to 25%). Opioid users, as well as those in the cocaine/crack and CNS stimulant groups, were most likely to indicate substance use while pregnant (30% to 33% versus 15% to 27%).

Women who used opioids had more challenging substance use issues than those in the other substance use groups, as evidenced by severity, IDU, polysubstance use, and prescription drug misuse. Their use also impacted their criminal offending as well as their health and that of their unborn children. Given the association with IDU, opioid use leads to adverse health issues, including blood borne diseases, skin infections, and the risk of overdose. Therefore, it is important to ensure that women offenders have access to appropriate health services and harm reduction programs while incarcerated, including Opioid Agonist Therapy, infectious disease screening and treatment for HIV and HCV.^{Footnote 3} Discharge planning at release ensures continuity of care and referrals to community harm reduction programs to support their reintegration.

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Prepared by: Sarah Cram and Shanna Farrell MacDonald