People who use drugs (PWUD) disproportionately experience health-related and social vulnerabilities, which may affect service needs and access during and after natural disasters. We conducted qualitative interviews with N = 18 PWUD recruited via a syringe services program in Houston, Texas. We assessed their health and social service needs, as well as related service access experiences, during and after natural disasters using a combined inductive–deductive approach. Participants described a range of service-related needs related to illicit drug use, poverty, neighborhood disadvantage, acute and chronic health problems, and housing insecurity. They endorsed decreased access to medical and substance-related services and difficulty accessing disaster relief aid. Interviews highlighted the importance of mutual aid for sharing harm reduction supplies and meeting practical needs. Results suggest that some PWUD experience disproportionate vulnerability after natural disasters related to multiple marginalized identities that intersect with illicit drug use.

The United States has one of the largest incarcerated populations per capita. Prisons are dangerous environments, with high in-prison and postrelease mortality. The Death in Custody Reporting Acts (DCRAs) of 2000 and 2013 require deaths of people in correctional custody or caused by law enforcement to be reported to the Bureau of Justice Assistance. These deaths must be reported within 3 months of the death and include 10 required fields (eg, age, cause of death). There is no public reporting requirement. Our Third City Mortality project tracks near-real-time data about individual deaths released publicly and prison system metadata, including data completeness and release speed, across (N = 54) US state, federal (N = 2; Bureau of Prisons, Immigration and Customs Enforcement), Washington, District of Columbia, and Puerto Rico prison systems. Twenty-one (38%) systems release no individual death data; 13 systems release incomplete data slower than 1 year; 19 release timely, but incomplete, death data; and only one system (Iowa) releases complete and timely data. Incomplete, untimely, public prison mortality data limit protective community responses and epidemiology.

In the United States, the opioid overdose crisis disproportionately affects incarcerated individuals, with opioid overdose risk in the two weeks after release 50 times higher than the general population. As a response, many prisons and jails are starting to offer medication for opioid use disorder (MOUD), including methadone or buprenorphine, during incarceration or prior to release. One implementation barrier is how to identify who would benefit from treatment, given that opioid use disorder screening and diagnostic testing are imperfect, particularly in criminal-legal settings. Prisons and jails use a variety of OUD assessment strategies, including brief self-report screening tools, diagnostic interviews, review of pre-incarceration medical records, and urine drug screening, all of which may lead to false positive and false negative results. In this essay, we apply a common framework from epidemiology and other fields to conceptualize OUD assessment in carceral settings: individuals assessed for OUD can be those with OUD who are correctly offered MOUD ("true positives"), those without OUD who are offered MOUD ("false positives"), those with OUD who are not offered MOUD ("false negatives"), and those without MOUD who are not offered MOUD ("true negatives"). We discuss these assessment and treatment outcomes from the perspectives of people who are incarcerated, security staff, and healthcare staff. This framework may inform discussions between medical staff and security personnel on the implementation of MOUD programs.

Background: Currently, there are more than two million people in prisons or jails, with nearly two-thirds meeting the criteria for a substance use disorder. Following these patterns, overdose is the leading cause of death following release from prison and the third leading cause of death during periods of incarceration in jails. Traditional quantitative methods analyzing the factors associated with overdose following incarceration may fail to capture structural and environmental factors present in specific communities. People with lived experiences in the criminal legal system and with substance use disorder hold unique perspectives and must be involved in the research process. Objective: To identify perceived factors that impact overdose following release from incarceration among people with direct criminal legal involvement and experience with substance use. Methods: Within a community-engaged approach to research, we used concept mapping to center the perspectives of people with personal experience with the carceral system. The following prompt guided our study: "What do you think are some of the main things that make people who have been in jail or prison more and less likely to overdose?" Individuals participated in three rounds of focus groups, which included brainstorming, sorting and rating, and community interpretation. We used the Concept Systems Inc. platform group wisdom for our analyses and constructed cluster maps. Results: Eight individuals (ages 33 to 53) from four states participated. The brainstorming process resulted in 83 unique factors that impact overdose. The concept mapping process resulted in five clusters: (1) Community-Based Prevention, (2) Drug Use and Incarceration, (3) Resources for Treatment for Substance Use, (4) Carceral Factors, and (5) Stigma and Structural Barriers. Conclusions: Our study provides critical insight into community-identified factors associated with overdose following incarceration. These factors should be accounted for during resource planning and decision-making.

The goal was to study the implementation of rapid BINAX COVID-19 testing at criminal justice reentry sites, focusing on framework-guided implementation outcomes. We implemented rapid COVID-19 testing at nine reentry sites in four states (Massachusetts, New Hampshire, Rhode Island, and New York) and collected test results to measure the (1) adoptability and (2) implementability of COVID-19 testing at reentry sites. We collected data on the acceptability, appropriateness, and feasibility of the implementation of COVID-19 testing using an anonymous employee Qualtrics survey. Testing was available to symptomatic and exposed residents and employees. COVID-19 testing results were collected from October 2021 to March 2022. Guided by the Expert Recommendations in Implementing Change (ERIC) framework, we chose nine implementation strategies to address barriers during the implementation process. Acceptability, appropriateness, and feasibility outcomes were captured from employees using validated measures. A total of 302 BINAX COVID-19 tests were used and 26 positive cases were identified. Forty-seven percent of employees participated in the survey. More than half of respondents either agreed or completely agreed with statements about the acceptability, appropriateness, or feasibility of COVID-19 testing. Funding and attention toward COVID-19 testing at reentry sites should be provided to help prevent the spread of COVID-19 in these sites.