Another potential unintended consequence of a tightening prescription opioid market is an increase in rates of other illegal behaviors and justice system involvement in persons with POUD. Specifically, one could hypothesize that as the prescription opioid supply has become more restricted, persons with POUD have become more likely to engage in acquisitive crime and illegal transactions to maintain their addiction. While previous studies have demonstrated associations between illegal behaviors and justice system involvement in persons with an opioid use disorder (OUD) (17–19), these studies have included persons with heroin use disorder (HUD). As heroin use itself is illegal, conclusions that can be drawn about the relationship between POUD and the justice system are limited. Interestingly, one recent cross-sectional study found that more than 50% of persons with POUD without co-morbid heroin use reported a lifetime history of justice system involvement and 20% reported being arrested within the past year (20). Whether this overlap has been affected by the decreasing supply of prescription opioids, however, is not known and has public health and policy implications as prisons contemplate their approach to
