How Should a Medical-Legal Partnership Address Unique Needs of People With Criminal Legal System Involvement?

Medical-legal partnerships (MLPs) are well suited to address health-harming legal needs associated with the collateral consequences of mass incarceration in the United States, such as those that limit access to food, housing, employment, and family reunification postrelease. MLP innovations seek to expand the current model to address patients' criminal, as well as postrelease, civil legal needs by including community health workers and some patients as legal partners and creating coalitions to promote local and state policy change. Overall, this article explains how these MLP innovations can support rights of people returning to communities after incarceration and can be leveraged to mitigate criminal legal system involvement.

Dark and bright personality dimensions as predictors of criminal behavior and recidivism.

A growing body of research highlights the continuum between dark and bright personality traits impacting individual prosocial or antisocial tendencies. However, the interplay between personality dimensions and actual criminal behavior and its reoccurrence is not fully elucidated. We aimed to explore the cumulative predictive value of the bright and dark core of personality for criminal history in differentiating a general community sample (N = 282) from a large sample of inmates (N = 296), with (n = 129) or without (n = 167) criminal history while controlling for age, sex and impression management. Predictors of first-time offending were higher levels of Neuroticism, Openness, Dark Factor, Sadism, and Deceitfulness. Criminal recidivism was predicted by high Neuroticism and Deceitfulness. Finally, higher levels of Extraversion were negatively related to criminal behavior and history, highlighting a potential protective effect of displaying assertive and sociable tendencies. The findings highlight the relevance of considering the dark personality core complementary to the typical personality dimensions in the risk assessment, prediction, and reduction of criminal behavior.

Access to Care and Outcomes With the Affordable Care Act for Persons With Criminal Legal Involvement: A Scoping Review.

Importance: By expanding health insurance to millions of people in the US, the Patient Protection and Affordable Care Act (ACA) may have important health, economic, and social welfare implications for people with criminal legal involvement-a population with disproportionately high morbidity and mortality rates. Objective: To scope the literature for studies assessing the association of any provision of the ACA with 5 types of outcomes, including insurance coverage rates, access to care, health outcomes, costs of care, and social welfare outcomes among people with criminal legal involvement. Evidence Review: The literature search included results from PubMed, CINAHL Complete, APA Psycinfo, Embase, Social Science Database, and Web of Science and was conducted to include articles from January 1, 2014, through December 31, 2023. Only original empirical studies were included, but there were no restrictions on study design. Findings: Of the 3538 studies initially identified for potential inclusion, the final sample included 19 studies. These 19 studies differed substantially in their definition of criminal legal involvement and units of analysis. The studies also varied with respect to study design, but difference-in-differences methods were used in 10 of the included studies. With respect to outcomes, 100 unique outcomes were identified across the 19 studies, with at least 1 in all 5 outcome categories determined prior to the literature search. Health insurance coverage and access to care were the most frequently studied outcomes. Results for the other 3 outcome categories were mixed, potentially due to heterogeneous definitions of populations, interventions, and outcomes and to limitations in the availability of individual-level datasets that link incarceration data with health-related data. Conclusions and Relevance: In this scoping review, the ACA was associated with an increase in insurance coverage and a decrease in recidivism rates among people with criminal legal involvement. Future research and data collection are needed to understand more fully health and nonhealth outcomes among people with criminal legal involvement related to the ACA and other health insurance policies-as well as the mechanisms underlying these relationships.

[Taking care of minor offenders: between methodological practices and experience.] / La presa in carico dei minori autori di reato: tra prassi metodologiche ed esperienza.

To fully respond to the provisions of the Judicial Authority relating to the care of minors and/or young adults subjected to judicial measures and affected by mental suffering and/or substance abuse, also with a view to a possible provision of placement in a therapeutic community, the UOSD "Protection of the Health of Adults and Minors in the Penal Area" - ASL Salerno has ensured operations through the establishment of a dedicated multidisciplinary team, made up of a psychiatrist, psychologist and social worker, as required by DGRC 567/2018, or as the only interface with the Judicial Authority in reference to healthcare. This article aims to describe the birth of the EMM (Equipe Multidisciplinare Minori), and of the methods used to take care of minors and/or young adult offenders affected by mental suffering and/or substance abuse. The article examines a sample of 207 minors, relating to the years 2018-2022, to highlight the most critical areas.

The role of truth in victim-offender mediation: Victims of crime who feel they know the "whole" truth are more receptive to apologies.

OBJECTIVE: We conducted three preregistered studies to examine whether victims of crime are more receptive to apologies in victim-offender mediation if they feel they know the "whole" truth about a crime. HYPOTHESES: We predicted that making salient the completeness (vs. incompleteness) of knowledge about a crime would lead victims to (a) have a greater sense of truth knowing and (b) view an apology more favorably. METHOD: Participants in Study 1 (N = 380; Mage = 41.2 years; 51% men; 78% White) and Study 2 (N = 550; Mage = 41.0 years; 65% women; 72% White) imagined being the victim of cybercrime. Participants in Study 3 (N = 670; Mage = 42.7 years; 52% men; 72% White) were real crime victims. Participants imagined taking part in victim-offender mediation during which the offender apologized, and then they evaluated the apology after answering questions that made salient what they either knew or did not know about the crime (complete knowledge salience vs. incomplete knowledge salience). Participants in Study 2 received additional information about the crime from either the offender or the police to test whether truth source acts as a moderator. RESULTS: Participants in the complete (vs. incomplete) knowledge salience condition reported greater truth knowing (Study 1 d = 1.40, Study 2 d = 1.26, Study 3 d = 0.58), readiness for an apology (Study 1 d = 0.25; Study 2 d = 0.23; Study 3 d = 0.09, nonsignificant), perceived completeness of an apology (Study 1 d = 0.26, Study 2 d = 0.31, Study 3 d = 0.19), and acceptance of an apology (Study 1 d = 0.22; Study 2 d = 0.21; Study 3 d = 0.10, nonsignificant). In Study 2, truth source moderated the effect only on apology acceptance (η2 = .009). Across the three studies, complete (vs. incomplete) knowledge salience was indirectly positively related to apology readiness, apology completeness, and apology acceptance (nonsignificant in Study 3), via truth knowing. CONCLUSIONS: Instances of victim-offender mediation should ensure that victims' need for truth is satisfied because this may increase the effectiveness of apologies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Network analysis of trait aggression among community youths and juvenile offenders.

OBJECTIVE: The mainstream view in trait aggression research has regarded the structure as representing the latent cause of the cognitions, emotions, and behaviors that supposedly reflect its nature. Under network perspective, trait aggression is not a latent cause of its features but a dynamic system of interacting elements. The current study uses network theory to explain the structure of relationships between trait aggression features in juvenile offenders and their peers. METHODS: Network analysis was applied to investigate the dynamic system of trait aggression operationalized by the Buss-Perry Aggression Questionnaire in a sample of community youths (Mage = 17.46, N = 715) and juvenile offenders (Mage = 18.36, N = 834). RESULTS: The facet level networks showed that anger is a particularly effective mechanism for activating all other traits. In addition, anger was more strongly associated with physical aggression and the overall network strength was greater in juvenile delinquency networks than in their peers. The item level networks revealed that A4 and A6 exhibited the highest predictability and strength centrality in both samples. Also, the Bayesian network indicated that these two items were positioned at the highest level in the model. There are similarities and differences between juvenile delinquents and community adolescents in trait aggression. CONCLUSION: Trait aggression was primarily activated by difficulty controlling one's temper and feeling like a powder keg.

Are you a cop?: Identifying suspicion in online chat operations with online groomers.

BACKGROUND: The increase in online enticement has led to law enforcement agencies engaging in more proactive policing through undercover chat sting operations. OBJECTIVE: We aimed to identify the topics and communication strategies triggering suspicion in chats between law enforcement officers and offenders and why those topics do not result in suspicion in victim-offender conversations. METHODS: We conducted a thematic analysis identifying: (1) how LEOs trigger suspicion, (2) how offenders communicate suspicion, (3) how LEOs attempt recovery from suspicion, and (4) how these triggers were present but did not trigger suspicion in victim-offender chats. We examined 20 LEO-offender chats and 20 victim-offender chats from US ICAC task forces. RESULTS: We identified four themes that triggered suspicion: risk assessment by the LEO's persona, LEO avoidance measures, details related to the offense and evidence, and proof of identity of chat participants. Offender responses to triggers revealed three themes: discomfort navigating boundaries and uncertainty, risk identification, and risk mitigation. Themes for the LEO's responses to suspicion included: risk assessment for chatters, issues with technology, appeasement, and negative emotional reactions. Finally, juxtaposing triggers onto minor-offender chats yielded four themes: explicit boundary setting, victim risk assessment, deep relationship forming and disclosures, and technology issues. CONCLUSION: This study has implications for law enforcement agencies seeking to reduce suspicion and risk assessment by offenders during internet sting operations.

Accessing child sexual abuse material: Pathways to offending and online behaviour.

BACKGROUND: Most research examining the consumption of online child sexual abuse material (CSAM) has focused on offenders' demographic and psychological characteristics. While such research may assist in the development of therapeutic interventions with known offenders, it has little to offer the development of interventions for the vast majority of offenders who are never caught. OBJECTIVE: To learn more about the offending strategies of CSAM offenders, in order to inform prevention efforts to deter, disrupt, and divert individuals from their pursuit of CSAM. PARTICIPANTS & SETTING: Seventy-five male CSAM offenders, who were living in the community and were voluntarily participating in a treatment programme. METHODS: Participants completed a detailed self-report questionnaire focussing on their pathways to offending and their online behaviour. RESULTS: Most participants reported that they did not initially seek out CSAM but that they first encountered it inadvertently or became curious after viewing legal pornography. Their involvement in CSAM subsequently progressed over time and their offending generally became more serious. The most notable feature of participants' online behaviour was the relative lack of sophisticated technical expertise. Opportunity and other situational factors emerged as mediators of offending frequency. Offending patterns were affected by participants' psychological states (e.g., depression, anger, stress), offline relationships and commitments (e.g., arguments with spouse, loss of job), and online experiences (e.g., blocked sites, viruses, warning messages). CONCLUSIONS: Findings suggest that many offenders are receptive to change and may be potentially diverted from their offending pathway.

Aberrant type 2 dopamine receptor availability in violent offenders with psychopathy.

Psychopathy is characterized by antisocial behavior, poor behavioral control and lacking empathy, and structural alterations in the corresponding neural circuits. Molecular brain basis of psychopathy remains poorly characterized. Here we studied type 2 dopamine receptor (D2R) and mu-opioid receptor (MOR) availability in convicted violent offenders with high psychopathic traits (n = 11) and healthy matched controls (n = 17) using positron emission tomography (PET). D2R were measured with radioligand [11C]raclopride and MORs with radioligand [11C]carfentanil. Psychopathic subjects had lowered D2R availability in caudate and putamen, and striatal D2R availability was also associated with degree of psychopathic traits in this prisoner sample. No group differences were found in MOR availability, although in the prisoner sample, psychopathic traits were negatively correlated with MOR availability in the amygdala and nucleus accumbens. We conclude that D2R signaling could be the putative neuromolecular pathway for psychopathy, whereas evidence for alterations in the MOR system is more limited.

Predictors of Criminal Sentiments Scale-Modified Scores in Outpatients with Legal System Involvement.

The Criminal Sentiments Scale-Modified (CSS-M) has been widely used as a measure of criminal attitudes. This analysis examined CSS-M scores in a large sample of outpatients with serious mental illnesses and a criminal legal system history. We compared total and subscale scores in our sample to scores from two other previously published U.S. studies in which the CSS-M was used, and evaluated associations between total CSS-M score and nine variables (age, educational attainment, gender, race, marital status, employment status, diagnostic category, substance use disorder comorbidity, and adverse childhood experiences (ACE) score). Scores were higher than in two prior U.S. studies involving other types of samples. Independently significant predictors of higher CSS-M scores included being younger (P < .001), having a higher ACE score (P < .001), being male (P = 03), not identifying as White (P < 001), not having a psychotic disorder (P < 001), and having a comorbid substance use disorder (P = 002). Future research should test the hypothesis that these factors increase risk for arrest and that arrest events, and subsequent criminal legal system involvement, are characterized by negative experiences and perceptions of poor procedural justice, which in turn underpin the negative opinions referred to as "criminal sentiments" or criminal attitudes.

The impact of testosterone-lowering medication on recidivism in individuals convicted of sexual offenses.

INTRODUCTION: Treatment of individuals who have committed sexual offences with Testosterone-Lowering Medication (TLM) is a comparatively intrusive kind of intervention, which regularly takes place in coercive contexts. Thus, the question of efficacy, but also the question of who should be treated, when and for how long, are of great importance. METHODS: Recidivism rates of TLM-treated high-risk individuals (+TLM; n = 54) were compared with high-risk individuals treated with psychotherapy only in the same forensic outpatient clinic (-TLM; n = 79). RESULTS: Group differences suggested a higher initial risk of + TLM (e.g. higher ris-assessment, previous convictions). Despite the increased risk, after an average time at risk of six years, +TLM recidivated significantly less often and significantly later than - TLM (27.8% vs. 51.9%). Such an effect was also found for violent (1.9% vs. 15.2%), but not for sexual (5.6% vs. 10.1%) and serious recidivism (5.6% vs. 10.1%), which could be explained partly by the small number of cases. In the course of treatment, TLM proved to be a significant variable for a positive process, whereas a high risk-assessment score indicated a rather negative course. In total, n = 19 individuals had stopped their TLM treatment, of these 31.6% recidivated. CONCLUSION: The results support the efficacy of TLM, particularly in the group of high-risk offenders.

Drogue, violence et résilience : consommateurs de drogue en cure et anciens délinquants violents à Dakar.

In Senegal, violent delinquency and illicit drug use are on the increase. This study focuses on two distinct groups: drug users (DUs) undergoing rehabilitation and violent ex-offenders (VEs). The methodology adopted includes a quantitative survey of the general population (n=1009), followed by a qualitative survey of fifteen participants, including eight DUs undergoing treatment at the Centre de prise en charge intégrée des addictions de Dakar (CEPIAD) (Integrated Addictions Management Center of Dakar) and the Centre Jacques Chirac de Thiaroye, and seven former VEs from the Grand Yoff district. This neighborhood, known for its violence, is juxtaposed with the Grand Yoff social housing estate, a residential area also affected by outbreaks of violence. This study aims to establish the link(s) between drug use and criminal violence by analyzing the life stories of young adults who have managed to leave drug use and delinquency behind. It then looks to identify the determinants of resilience in certain young people. The study revealed delinquent violence among young people does not systematically result from drug use. Rather, drug use is a factor conducive to violence. The links between drugs and violence depend on individual predisposition, the type of drugs used, and the level of addiction. Resilience results from a web of individual, sociocultural, and environmental factors. It is not static, but rather the result of a series of successes, failures, and even relapses.

Testing a hybrid risk assessment model: Predicting CSAM offender risk from digital forensic artifacts.

BACKGROUND: Recent research argues for a formalized hybrid risk assessment model that combines the current online child sex abuse risk measures with digital forensics artifacts. OBJECTIVE: We conducted a feasibility study as an initial step toward formalizing the hybrid risk assessment model by identifying high-level digital forensic artifacts that have the potential to be valid and reliable indicators of risk, with a focus on CPORT Items 5, 6, and 7. DATA: Law enforcement investigators from a High Tech Crime Unit (HTCU) randomly selected seven closed cases; selection criteria included: male offender over 18, mobile device, child sexual abuse material (CSAM) offense, and 2019-2023 index offense. Investigation details related to probable cause, final charges, conviction, and offender risk were not disclosed. Statistical information (f, %) for the following digital forensics artifacts was examined: 1) pornography collection (e.g., % of media, content type, gender ratio) and 2) evidence of networking/grooming and other problematic online activities (e.g., number of native messages vs. application messages; type of installed apps). METHOD: The analysis predicted whether the offender was a CSAM-only or dual offender and if our findings agreed with the level of risk for reoffending suggested by CPORT Items 5, 6, and 7. Results were shared with the HTCU and scored for accuracy. RESULTS: The hybrid model was accurate in 6 of 7 cases. CONCLUSION: We conclude a hybrid model is feasible, and the findings illustrate the importance of analyzing app artifacts for context. Study limitations and future research recommendations are discussed.

A comparison of patient ratings and staff ratings of disability using the World Health Organisation Disability Assessment Schedule in individuals with psychotic spectrum disorders who are forensic psychiatric inpatients.

BACKGROUND: Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients. AIMS: To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors. METHODS: Seventy-three patients self-rated on the WHODAS after 3 months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared. RESULTS: Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings. CONCLUSION: Our mean WHODAS score findings echoed those in other patient samples-of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning.

Identifying victim types in sexual homicide: A latent class analysis using interactional victimology theories.

Sexual homicide (SH) research has focused on those who commit these crimes and the crimes themselves. This leaves the victim, an equally crucial piece to the puzzle, left as a sort of afterthought, despite the valuable insight that victimology provides to the crime. For the current study, victim information related to their routine activities and lifestyles was taken from an international database containing 662 solved cases of SH. Nine victim variables were used in a latent class analysis to find hidden subgroups within the victim population. Three classes were identified-low-risk, homebody, and overt risk victims-which suggests that SH victimization varies depending on the victim lifestyles and routine activities. These groups were externally validated by examining their association with different phases of the crime commission process. Some sexual homicide offenders may be more drawn to a victim because they present as vulnerable and opportunistic, while others might be methodically targeted. The theoretical relevance of this typology, along with investigative and prevention strategies, is discussed.

Probation practice and attention-deficit hyperactivity disorder.

RATIONALE: Twenty-one Community Rehabilitation Companies were set up following the division of the National Probation Services during 'Transforming Rehabilitation' in England and Wales, under a 2013 Ministry of Justice initiative. Reunification commenced in 2018. A study completed prior to these changes suggested that probation officers had had little training in recognising attention-deficit hyperactivity disorder (ADHD) and may have been underestimating its prevalence among their clientele. Given the substantial changes in probation staffing and organisation since 2018, a new study seems warranted. AIMS: The aim of the study was to understand experiences of people under a community sentence who reported having ADHD and of probation staff working with them. METHODS: Using a qualitative research design, one-to-one semi-structured interviews were conducted with client facing probation staff recruited from one Community Rehabilitation Company. Service users undertaking a community sentence who had been diagnosed with or self-identified as having ADHD were then identified and recruited by these staff; those who consented were also interviewed. Transcripts were analysed using a thematic analytic approach. RESULTS: Thirteen probation staff and six male offenders under community sentences, agreed to participate and completed interviews. The overarching themes emerging from the two groups were similar, both reflecting on descriptions of ADHD; treatment of ADHD; experiences of having or working with ADHD in the wider community and in the criminal justice system specifically and visions of future support needs tied to the order. In addition, probation officers specifically raised the matter of payment by results. Both service users and probation staff identified gaps in knowledge, experience and services, but areas of good practice were also identified. CONCLUSION: The findings highlight the continuing under-acknowledgement of tailored clinical support for people serving a community sentence who have ADHD together with a lack of support and training about ADHD for probation staff. Return to the national organisation of probation services and recognition of need for a range of relevant skills offers a great opportunity for re-evaluating supervision and management of offenders under community sentences who have ADHD. These findings provide the basis for a template for developing knowledge and support provision for probation staff to recognise ADHD, or its likelihood, and their capacity to follow through with appropriately informed personalised supervision plans and access to specialist service advice and support.

Contact sex offenders with adult and minor victims: Psychopathological and criminological differences.

BACKGROUND: Effective classification of individuals who commit sexual offences is important for their assessment, treatment, and risk management. Victim age has often been used as a distinguishing factor between perpetrators. OBJECTIVE: This study aimed to analyse the distinctive psychopathological and criminological characteristics of contact sexual offenders with adult and minor victims. PARTICIPANTS AND SETTING: The study involved 97 adult males who were serving a prison sentence in Spain for at least one contact sexual offence against an adult or a minor. METHODS: Researchers gathered data on criminological variables concerning the offender, victim, and modus operandi from prison records and interviews. Participants completed the Millon Clinical Multiaxial Inventory-III (MCMI-III) in a second session, and between-group differences were analysed. RESULTS: Sex offenders with minor victims (SOMV) had significantly lower scores than sex offenders with adult victims (SOAV) on the Antisocial (r = -0.283, p = .005) and Sadistic (r = -0.209, p = .04) personality subscales, and on the Alcohol (r = -0.426, p < .001) and Drug dependence (r = -0.332, p = .001) syndrome subscales. SOAV were also more likely to use violence and/or intimidation, use a weapon, offend against female victims, offend against an intimate partner, commit their offences in public places, serve other ongoing prison sentences, and report a history of alcohol and substance abuse. SOMV were older and more likely to offend against family members. CONCLUSIONS: These results suggest that there are key differences between SOAV and SOMV that should be considered in tailored prevention programmes for each subgroup of offenders.

A multi-factor knuckle and nail bed verification tool for forensic imagery analysis.

BACKGROUND: The grooming process involves sexually explicit images or videos sent by the offender to the minor. Although offenders may try to conceal their identity, these sexts often include hand, knuckle, and nail bed imagery. OBJECTIVE: We present a novel biometric hand verification tool designed to identify online child sexual exploitation offenders from images or videos based on biometric/forensic features extracted from hand regions. The system can match and authenticate hand component imagery against a constrained custody suite reference of a known subject by employing advanced image processing and machine learning techniques. DATA: We conducted experiments on two hand datasets: Purdue University and Hong Kong. In particular, the Purdue dataset collected for this study allowed us to evaluate the system performance on various parameters, with specific emphasis on camera distance and orientation. METHODS: To explore the performance and reliability of the biometric verification models, we considered several parameters, including hand orientation, distance from the camera, single or multiple fingers, architecture of the models, and performance loss functions. RESULTS: Results showed the best performance for pictures sampled from the same database and with the same image capture conditions. CONCLUSION: The authors conclude the biometric hand verification tool offers a robust solution that will operationally impact law enforcement by allowing agencies to investigate and identify online child sexual exploitation offenders more effectively. We highlight the strength of the system and the current limitations.

Buprenorphine-naloxone vs. extended-release naltrexone for opioid use disorder in individuals with and without criminal legal involvement: A secondary analysis of the X:BOT randomized controlled trial.

INTRODUCTION: There is uncertainty about whether criminal legal involvement (CLI) impacts the effectiveness of medications for opioid use disorder (MOUD). We aimed to determine whether CLI modifies the association between buprenorphine-naloxone (BUP-NX) vs. extended-release naltrexone (XR-NTX) and MOUD treatment outcomes. METHODS: We conducted a secondary analysis of X:BOT, a 24-week multi-center randomized controlled trial comparing treatment outcomes between BUP-NX (n = 287) and XR-NTX (n = 283) in the general population. We used baseline Additional Severity-Index Lite responses to identify patients with recent CLI (n = 342), defined as active CLI and/or CLI in the past 30 days, and lifetime incarceration (n = 328). We explored recent CLI and lifetime incarceration as potential effect modifiers of BUP-NX vs. XR-NTX effectiveness on relapse, induction, and overdose. We conducted both intention-to-treat and per-protocol analyses for each outcome. RESULTS: In intention-to-treat analyses, recent CLI modified the effect of BUP-NX vs. XR-NTX on odds of successful induction (p = 0.03) and hazard of overdose (p = 0.04), but it did not modify the effect on hazard of relapse (p = 0.23). All participants experienced lower odds of successful induction with XR-NTX compared to BUP-NX, but the relative likelihood of successful induction with BUP-NX was lower than XR-NTX among individuals with recent CLI (OR: 0.25, 95 % CI: 0.13-0.47, p < 0.001) compared to those without recent CLI (OR: 0.04, 95 % CI: 0.01-0.19, p < 0.001). Participants with recent CLI experienced similar hazard of overdose with XR-NTX and BUP-NX (HR: 1.12, 95 % CI: 0.42-3.01, p = 0.82), whereas those without recent CLI experienced greater hazard of overdose with XR-NTX compared to BUP-NX (HR: 12.60, 95 % CI: 1.62-98.03, p = 0.02). In per-protocol analyses, recent CLI did not modify the effect of MOUD on hazard of overdose (p = 0.10) or relapse (p = 0.41). Lifetime incarceration did not modify any outcome. CONCLUSIONS: Compared to individuals without recent CLI, individuals with recent CLI experienced decreased relative effectiveness of BUP-NX compared to XR-NTX for induction and overdose outcomes. This highlights the importance of considering the impact of recent CLI on opioid use disorder treatment outcomes. Future research should explore the mechanisms through which recent CLI modifies MOUD effectiveness and aim to improve MOUD effectiveness for individuals with recent CLI.