Decades of strict sentencing laws, the racially motivated “war on Drugs,” and simultaneous erosion of community mental health and social services have contributed to the American public health crisis of mass incarceration. The mass incarceration system includes jails (county institutions holding people who are awaiting trial or serving short sentences) and prisons (state or federal facilities holding people after conviction), as well as community supervision (probation and parole). In 2021, a total of 1.2 million people were incarcerated in U.S. prisons, and 11 million people cycled through jails — numbers that are 7 times as high as those in the late 1970s. The United States now holds 20% of the world’s incarcerated people, although it accounts for just 5% of the global population.

In the USA, people with a history of criminalized drug use and drug use disorders reentering the community after incarceration frequently experience adverse health outcomes including overdose, suicide, and infectious disease acquisition. This review presents a conceptual model for understanding risk pathways for these outcomes related to post-release psychosocial needs. We first summarize the literature on post-release needs experienced by people who use criminalized drugs during reentry in multiple domains, including basic needs and those related to relationships as well as medical, mental health, and substance use problems. Drawing from a socioecological model, we demonstrate how vulnerability factors related to criminal legal involvement and criminalized drug use operate at intrapersonal (i.e., individual), interpersonal, institutional, community, and policy levels to negatively affect the ability of people who use drugs to meet each of these types of needs. We present research demonstrating that when people leaving incarceration are met with the overwhelming task of addressing competing demands, they often experience strong negative affect, which can lead to risk-conferring behaviors including criminalized drug use. Competing needs also create environmental conditions that amplify risk. We argue for the importance of interventions that address determinants of post-release health at individual and social-environmental levels to prevent adverse outcomes.

Incarcerated individuals are at a high risk of substance use-related death after release. While prior research has demonstrated that this is partially due to loss of tolerance during incarceration and return to use after release, structural and healthcare use factors that may also impact overdose risk have been underexplored. We assessed the relationship between structural factors (e.g., housing services received) and health care use (e.g., emergency department use) and overdose risk at 12-months post-incarceration in Rhode Island in the United States.

The prevention and control of infectious disease outbreaks in carceral settings face unique challenges. Transmission modeling is a powerful tool for understanding and addressing these challenges, but reviews of modeling work in this context pre-date the proliferation of outbreaks in jails and prisons during the SARS-CoV-2 pandemic. We conducted a systematic review of studies using transmission models of respiratory infections in carceral settings before and during the pandemic.

Individuals impacted by the criminal-legal system face increased risk of opioid overdose. Medications for opioid use disorder (MOUD) provide a life-saving intervention. Multiple barriers prevent access to MOUD, including federal policies regulating opioid treatment programs (OTPs). This study aims to identify how federal policy affects anticipated barriers to methadone treatment access at a high-risk time for opioid mortality: community re-entry after incarceration.