To our knowledge, this study is the first to examine associations between POUD and illegal behaviors over time while controlling for trends in the general population. The greater prevalence of illegal behaviors among the POUD group compared to the general population at every time point indicates the association between POUD and engagement in illegal activities is longstanding. This is especially notable as prescription opioids are licit substances, commonly received from physicians, and thus may not be thought of intuitively as conferring an increased risk of engagement in illegal behaviors. Further, our findings suggest that opioid supply-side interventions may have had the unintended consequence of increased prevalence of illegal behaviors and justice system involvement among persons with POUD. While methodological changes in the NSDUH precluded trend analyses of associations between POUD and illegal behaviors for years after 2014, there have been continued supply-side interventions in more recent years, including a continued decrease in the number of opioid prescriptions (11), the release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain (33) and the 2017 Veteran’s Administration and Department of
