• Saba Rouhani, Lingzi Luo, Himani Byregowda, Nicholas Weaver, and Ju Nyeong Park.
• Department of Epidemiology, New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA; Center for Anti-racism, Social Justice and Public Health, New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA. Electronic address: Saba.rouhani@nyu.edu.
• Prev Med. 2024 Aug 1; 185: 108058108058.

ObjectiveFollowing changes to drug criminalization policies, we re-examine the epidemiology of drug arrests among people who use drugs (PWUD) in the U.S.MethodsSerial cross-sectional data from the National Survey on Drug Use and Health (2015-2019) were utilized. Past-year illicit drug use (excluding cannabis) and drug arrests were described by year, area of residence, drug use characteristics and participant demographics. Adjusted associations between race and drug arrest were estimated using multivariable logistic regression.ResultsPast-year illicit drug use remained consistent over time and was highest among non-Hispanic (NH) white respondents. Of those reporting past-year illicit drug use (n = 25,429), prevalence of drug arrests remained stable over time overall and in metro areas while increasing in non-metro areas. Arrests were elevated among NH Black participants and those with lower income, unemployment, housing transience, non-metro area residence, polysubstance use, history of drug injection, substance use dependence and past-year drug selling. Adjusted odds of drug arrest remained significantly higher among NH Black individuals [aOR 1.92, 95% CI 1.30, 2.84].ConclusionDespite recent shifts away from punitive drug policies, we detected no reduction in drug arrests nationally and increasing prevalence in non-metro areas. Despite reporting the lowest level of illicit substance use and drug selling, NH Black individuals had significantly increased odds of arrest across years. Findings highlight the need for further examination of policy implementation and policing practices in different settings, with more research focused non-metro areas, to address enduring structural racism in drug enforcement and its consequences for health.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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