Table 2 Summary of key qualitative themes according to Risk Environment Framework domains
Micro-environment | Macro-environment | |
|---|---|---|
Physical | Drug injecting practices Tolerance loss during incarceration Underdosing of MOUD Polysubstance use | Toxic drug supply High prevalence of fentanyl Location of recovery services and proximity to areas of high drug use |
Social | Social and peer group risk norms Social support networks Peer-driven harm reduction | Lack of accessible housing Community support networks Low availability of mental healthcare Community experience with overdose |
Economic | Lack of income generation during incarceration Community reentry support | Employment stigma against people with history of criminal-legal system involvement |
Policy | Availability of harm reduction materials (sterile injection supplies, naloxone, etc.) Implementation of health services | Drug laws Legislative mandate for MOUD provision in MA jails |