Factors associated with adult incarceration among people with opioid use disorder in New South Wales, Australia

<div><b>Background and purpose</b>: </div><div>People with opioid use disorder (OUD) are at elevated risk of incarceration. Understanding factors linked to this risk may support more targeted prevention and intervention efforts. This study used cross-sectional survey data to examine associations with time to first incarceration and repeated incarceration among individuals with OUD. Additionally, we wanted to examine the characteristics of people with opioid dependence who had been incarcerated. </div><div><br/></div><div><b>Methods</b>: </div><div>Data were drawn from 297 adults with OUD in NSW, Australia (2023-2024). Participants completed structured interviews covering socio-demographics, substance use, adverse childhood experiences and criminal justice contact. A discrete-time event analysis examined correlates of first adult incarceration from age 18.</div><div><br/></div><div><b>Results</b>: </div><div>Overall, 58% of participants reported having been incarcerated. In adjusted models, injecting drug use increased risk of first-time incarceration in any given year (aOR: 3.55, 1.08 – 11.66), as did childhood exposure to household substance use (aOR: 1.80, 1.15–2.82), and being male (aOR: 1.83, 1.24 – 2.69). Greater secondary education reduced incarceration odds (aOR: 0.56, 0.37–0.86). In any given year, younger adults (18–24 years) were at highest risk of incarceration, whereas those aged 35 or older had notably lower odds (aOR: 0.16, 0.09 – 0.29).</div><div><br/></div><div><b>Conclusions</b>: </div><div>Injecting drug use, limited education, and childhood exposure to household substance use were associated with higher incarceration risk. There is a need to consider broader social and developmental factors in supporting individuals with OUD. While systemic change is complex, this study adds to the evidence base that can inform more integrated approaches to reducing incarceration risk.</div>