U.S. Jails and fatal drug overdoses: patterns, predictors and the role of rehabilitative contexts.

Opioid-related fatalities in U.S. correctional facilities present a critical criminal justice and health challenge. This study examines predictors of drug- and opioid-related deaths among incarcerated individuals nationwide. In the main models, younger age increases overdose risk, females face higher odds of drug-related death than males, and shorter stays are linked to all drug-related deaths, while longer stays are associated with opioid fatalities. Geographic disparities emerge, with small metro and micropolitan areas showing higher drug death rates and large fringe metros showing significantly lower opioid death rates. Medium-security facilities and greater spatial distance from public transportation access points predict higher rates for both outcomes. Subgroup analyses reveal that conviction status predicts elevated drug-related mortality only among males and among individuals held longer than 17 days. Notably, over one-third of opioid-related deaths and more than half of other drug deaths occur within 24 h of incarceration, underscoring acute early-stage vulnerability. Findings reveal distinct and overlapping predictors shaped by both rehabilitative and punitive factors, informing policies and interventions to reduce overdose fatalities in jails.