The cyclical and intersecting influence of substance use, homelessness and criminal legal policy on risk among minoritized people who use drugs.

Authors

Molly C Reid, Victoria Haworth, Samantha J Harris, Sean Allen, Sara Whaley, Daliah Heller, Tracy Pugh, Dionna King, Sachini Bandara, Brendan Saloner

Published in

Social science & medicine (1982). Pages 119964. Oct 19, 2026. Epub Oct 19, 2026.

Abstract

The US has seen an alarming rise in overdose mortality among people experiencing homelessness and incarceration. Drug overdose and homelessness are dual crises that disproportionately impact Black, Hispanic, and American Indian/Alaska Native communities due to historic and ongoing structural racism. Our objective was to better understand the intersection of substance use, homelessness, and criminal-legal involvement among these populations to inform harm reduction and policy. We completed in-depth semi-structured interviews with racially minoritized people who use drugs (PWUD) in Michigan, New Jersey, and Wisconsin. This analysis focused on 54 participants currently or previously experiencing homelessness. We conducted a thematic analysis informed by the risk environment framework, which considers structural factors related to substance use. Participants identified a cyclical relationship between homelessness and substance use that was highly influenced by the policy risk environment. Substance use was shaped by the risk environment of homelessness, and untreated substance use led to homelessness. This synergy was exacerbated by criminal-legal involvement, including incarceration without treatment and exclusion from resources based on criminal histories. Participants described experiences living in racially segregated neighborhoods, which were important potential access-points for social services. Participants also noted the need for housing and treatment outside of the environments where their substance use and homelessness began. Our study describes risk environments that contribute to cyclical substance use, homelessness, and criminal-legal involvement among racially minoritized PWUD. To address overdose trends, it is imperative to expand equitable access to harm reduction and housing and reform criminal-legal policies surrounding substance use and unsheltered living.

PMID:
42901863
Bibliographic data and abstract were imported from PubMed on 21 Oct 2026.

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