Understanding the link between opioid use and criminal behavior is critical for criminal justice and public health initiatives, highlighting the societal impacts of opioid abuse and its contribution to criminal activities. In the first part of this analysis, Nevada’s statewide Criminal History Repository was used to understand how substance use, including but not limited to opiates, among individuals in the Nevada criminal justice system from 2016 to 2023 influenced criminal behavior. By analyzing data on drug-related arrests and convictions, the study explores the relationship between substance use and crime, aiming to inform interventions and policies that reduce drug-related criminality and improve public safety and health outcomes. Part two of this study investigates drug use specifically among forensic patients at Stateran forensic hospitals from fiscal years 2021 to 2023. The study contextualizes these findings within the broader national drug crisis, noting the significantly higher substance-use rates among people on parole or probation compared to the general population, and the critical role of Opioid Use Disorder (OUD) medications in reducing mortality and recidivism post-incarceration.