Overdose Deaths and Jail Incarceration

Using Data to Confront Two Tragic Legacies of the U.S. War on Drugs


For decades, people who use drugs have been harmed by policies that advance enforcement and punishment at the expense of community-based health services and supports. Incarceration is antithetical to any meaningful response to the overdose crisis—and may even exacerbate it. Substantial evidence shows that incarceration is associated with increased risk of overdose death due to a loss of tolerance to opioids, limited access to harm reduction and treatment services, and disruptions in health care and social support during and after periods of incarceration.Paul J. Joudrey, Maria R. Khan, Emily A. Wang et al., “A Conceptual Model for Understanding Post-Release Opioid-Related Overdose Risk,” Addiction Science & Clinical Practice 14 (2019), 17, https://perma.cc/F9UB-3NZU. Also see Lauren Brinkley-Rubinstein, Nickolas Zaller, Sarah Martino et al., “Criminal Justice Continuum for Opioid Users at Risk of Overdose,” Addictive Behaviors 86 (2018), 104–10, https://doi.org/10.1016/j.addb...; Ingrid A. Binswanger, Marc F. Stern, Richard A. Deyo et al., “Release from Prison—A High Risk of Death for Former Inmates,” New England Journal of Medicine 356, no. 2 (2007), 157–65, https://perma.cc/L49X-7MZ7; and Shabbar I. Ranapurwala, Meghan E. Shanahan, Apostolos A. Alexandridis et al., “Opioid Overdose Mortality Among Former North Carolina Inmates: 2000–2015,” American Journal of Public Health 108, no. 9 (2018), 1207–13, https://doi.org/10.2105/AJPH.2018.304514. Since 1980, as rates of jail incarceration have increased, so too have rates of overdose death.

Against this backdrop, communities of color have shouldered much of the burden of a punitive criminal legal system, while confronting deep inequities in access to health care and other social services. Preliminary data also suggests that the COVID-19 pandemic has contributed to increased overdose death among people who use drugs, as well as untold suffering and death among people detained in America’s jails and prisons, who are disproportionately Black or Latinx and low-income.F.B. Ahmad, L.M. Rossen, and P. Sutton, “Provisional Drug Overdose Data,” database (Washington, DC: Centers for Disease Control and Prevention [CDC], National Center for Health Statistics [NCHS]), retrieved August 4, 2020, https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm; Joan Stephenson, “Drug Overdose Deaths Head Toward Record Number in 2020, CDC Warns,” JAMA Health Forum, October 20, 2020, https://perma.cc/LN29-52GX; William Wan and Heather Long, “‘Cries for Help’: Drug Overdoses Are Soaring during the Coronavirus Pandemic,” Washington Post, July 1, 2020, https://www.washingtonpost.com/health/2020/07/01/coronavirus-drug-overdose/; Josh Katz, Abby Goodnough, and Margot Sanger-Katz, “In Shadow of Pandemic, U.S. Drug Overdose Deaths Resurge to Record,” New York Times, July 15, 2020, https://www.nytimes.com/interactive/2020/07/15/upshot/drug-overdose-deaths.html; Zachary Siegel, “The Coronavirus Is Blowing Up Our Best Response to the Opioid Crisis,” New Republic, July 29, 2020, https://newrepublic.com/article/158645/coronavirus-blowing-best-response-opioid-crisis; Mike Stobbe and Adrian Sainz, “US Overdose Deaths Appear to Rise Amid Coronavirus Pandemic,” AP NEWS, October 20, 2020, https://apnews.com/article/virus-outbreak-technology-pandemics-kentucky-22e4c7213a3f5a857cd50b8489325d9a; Adam Looney and Nicholas Turner, “Work and Opportunity Before and After Incarceration” (Washington, DC: The Brookings Institution, 2018), https://www.brookings.edu/research/work-and-opportunity-before-and-after-incarceration/; Bernadette Rauby and Daniel Kopf, “Prisons of Poverty: Uncovering the Pre-Incarceration Incomes of the Imprisoned” (Northampton, MA: Prison Policy Institute, 2015), https://www.prisonpolicy.org/reports/income.html.

As jurisdictions across the country face budget shortfalls from the economic consequences of the COVID-19 pandemic, they must reconsider how they can most effectively safeguard the health of community members.For an overview of the effects of the pandemic on state budgets, see “Coronavirus (COVID-19): Revised State Revenue Projections,” database (Washington, DC: National Conference of State Legislatures [NCSL], updated November 11, 2020), https://www.ncsl.org/research/fiscal-policy/coronavirus-covid-19-state-budget-updates-and-revenue-projections637208306.aspx. Jurisdictions must prioritize investments in community-based treatment, harm reduction, and recovery rather than incarceration. The data and resources provided in this special report are designed to help communities realize these goals. The data, case studies on New Mexico and North Carolina, and resources provided in this special report are designed to help communities realize these goals.

Key takeaways

Resources and responsibility for responding to drug use must be moved away from the criminal legal system and into non-punitive, health-oriented services located in, and led by, communities. Until then, local jurisdictions must take steps to minimize the harms of criminal legal system contact for people who use drugs.

  • When counties spend money on jails, they have less money to spend on substance use treatment, harm reduction services, and other community-based resources that could prevent overdoses and improve community health and wellness.
  • Incarceration can increase the risk of overdose for people returning to their communities.
  • Improving access to substance use treatment and harm reduction supports in jails can address incarcerated people’s immediate needs, but cannot replace community-based responses.