Allocation of federal funding to address the opioid overdose crisis in the criminal legal system

Introduction: The opioid overdose crisis remains a chief public health concern in the United States, and people involved in the criminal legal system are among the most vulnerable to opioid related harms. This study aimed to identify all discretionary federal funding allocated to states, cities, and counties targeting the overdose crisis for criminal legal system-involved populations in fiscal year (FY) 2019. We then aimed to assess the extent to which federal funding was allocated to states with the highest need. Methods: We collected data from publicly available government databases (N = 22) to identify federal funding targeting opioid use disorder in criminal legal system–involved populations. Descriptive analyses examined the extent to which funding allocated per person in the criminal legal system-involved population was associated with funding need, proxied by a composite measure of opioid mortality and drug-related arrests. We created a generosity measure and dissimilarity index to assess the degree to which funding matched need across states. Results: More than 590 million dollars were allocated across 517 grants by 10 federal agencies in FY 2019. About half of states received less than $100.00 dollars per capita in the state criminal legal system-involved population. Funding generosity ranged from 0 % to 504.2 %, with more than half of states (52.9 %, n = 27) receiving fewer dollars per opioid problem than the US average. Further, a dissimilarity index indicated that about 34.2 % of funding (~$202.3 million) would have to be reallocated to distribute funding more evenly across states. Conclusions: Results suggest that additional efforts are needed to more equitably distribute funds to meet the needs of states with more severe opioid problems.