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Am Fam Physician. 2023;108(3):295-300

Author disclosure: No relevant financial relationships.

Case Scenario

D.H., a 24-year-old patient with opioid use disorder, presents to my clinic for care following minor injuries sustained during an altercation with the police. D.H. spent the weekend in a detention center before being able to post bail. During initial screening for mental health and substance use, D.H. reports symptoms of hypervigilance and increased opioid cravings. What specific clinical or medicolegal issues should I, as the treating family physician, consider or be aware of to optimize the quality of care provided to this patient?


Justice system involvement is defined as regular interactions with legal, law enforcement, and carceral systems, including detention, incarceration, or community supervision1; Table 1 outlines common justice system involvement definitions.2 In 2020, the Bureau of Justice Statistics stated that around 21% of U.S. residents (nearly 54 million people) 16 years or older had some type of contact with the police.3 More than 50% of those contacts (more than 25 million) were initiated by the police (i.e., traffic stops, arrests).3 Although the number has been decreasing in the past few years, in 2020 an estimated 5.5 million people were under correctional system control, which includes incarceration and community supervision.3

Jail (e.g., detention center)Location where a person is detained before trial for their accused crime; time spent is typically less than two years; generally run by a local municipality (e.g., county, city)
PrisonLocation where a person is incarcerated after sentencing; time spent is dependent on sentencing; usually run by a state or federal agency
Community supervisionGeneral term that includes parole and probation and may include conditions in which the justice system monitors the individual for certain actions (e.g., substance use); if the individual engages in such actions, they may be liable to further sentencing or incarceration
ProbationCourt-ordered period of correctional supervision in the community that is generally an alternative to incarceration; may involve the use of ankle monitors, which can be associated with health consequences2
ParolePeriod of supervision in the community, which is generally after incarceration; may involve the use of ankle monitors, which can be associated with health consequences2

Profound racial disparities are evident in rates of street stops (e.g., traffic, foot patrol), use of force, arrests, pretrial detention, incarceration, and sentencing.3,4 Overrepresentation of Black and Hispanic individuals in the justice system is a concern, especially given historic and current law enforcement practices, such as overpolicing communities of color.5,6


Patients with justice system involvement face stigmatization in most areas of society, including health care. To minimize bias, family physicians should first identify and address their own personal biases regarding people with justice system involvement, substance use disorders (SUDs), or mental health disorders. Family physicians should be cognizant of the variety of psychosocial challenges that patients with justice system involvement experience7,8 and of their patients' potential mistrust of major institutions, including the medical system.9 Family physicians should engage in trauma-informed care with this population.10 Table 2 provides a list of resources for family physicians to reference when caring for a patient who is involved with the justice system.

General guidelines
Social drivers of health (e.g., connecting individuals involved in the justice system with key income support, health insurance)211
Comprehensive source of information about local resources and services
American Academy of Family Physicians
The EveryONE Project: assessment and action
Aunt Bertha
Website dedicated to helping people find and connect to social services in their area
Leading Into New Communities
Language of incarceration
State Policies Connecting Justice-Involved Populations to Medicaid Coverage and Care
Substance Abuse and Mental Health Services Administration
FAQs for working with people who are involved with the justice system
Reentry guidance
State and federal resources for system-based approaches to enhance the health of individuals who are reentering the general populationCenters for Disease Control and Prevention
Reentry for people who were formerly incarcerated
Correctional health resources
Library of Congress
Reentry and employment resources for justice-involved individuals
Substance Abuse and Mental Health Services Administration
Reentry resources for individuals, providers, communities, and states
Sharing of information with law enforcement
Issues of verbal or oral consent to release information, perform justice system–requested examinations, and maintain confidentialityAmerican Hospital Association
Guidelines for releasing patient information to law enforcement
Council of State Governments Justice Center
Information sharing in criminal justice-mental health collaborations: working with HIPAA and other privacy laws
Tessier W, Keegan W. Mandatory blood testing: when can police compel a health provider to draw a patient's blood to determine blood levels of alcohol or other intoxicants? Mo Med. 2019; 116(4): 274–277.
Special populations
Women, adolescents, LGBTQIA individualsNational Institute of Corrections
National Resource Center on Justice-Involved Women
Georgetown University
Center for Juvenile Justice Reform: publications
Institute for Justice Research and Development
Working with justice-involved LGBTQ+ individuals—mutual respect
Movement Advancement Project
Unjust: LGBTQ Youth Incarcerated in the Juvenile Justice System
Prison Policy Initiative
Visualizing the unequal treatment of LGBTQ people in the criminal justice system


The population involved in the justice system has an increased prevalence of a variety of health-related conditions compared with the general population.1,11 These conditions include severe mental health disorders (including schizophrenia, bipolar disorder, and posttraumatic stress disorder); SUDs (including alcohol, opioids, and stimulants); and infectious diseases associated with SUDs (e.g., hepatitis C, HIV/AIDS), sexual activity, and congregate settings (e.g., tuberculosis, COVID-19). Other chronic conditions, such as obesity, hypertension, and type 2 diabetes mellitus, are also included.1,11,12 In addition, individuals with justice system involvement are more likely to experience negative social drivers of health, including financial insecurity, housing instability, poverty, and a history of adverse childhood experiences.1,11,12

When engaging with patients involved in the justice system, family physicians can focus on exposures related to the four major types of interaction with the justice system: (1) community-based interactions with law enforcement (e.g., during policing activities, crowd-control events during protests, excessive use of force during traffic stops), (2) detention, (3) incarceration, and (4) community reentry, especially if community supervision is required. Table 3 outlines the major conditions associated with exposure type as well as potential actions family physicians might take to address these conditions.1,2,10,1220

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Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at

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