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Substance Use Disorder and Substance Use-Related Mortality in US Immigration Detention (2018-2025).

Brian Tirado, Ruth Ling, Lisa Gong

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    Deaths in US Immigration and Customs Enforcement (ICE) custody show probable gaps in substance use disorder (SUD) identification and treatment. Untreated SUD complications and delayed emergency response contributed to fatalities, highlighting a need for improved protocols.

    Keywords:
    delivery of health careimmigration detentionmortalityprisonerssubstance-related disordersunderserved populations

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    Area of Science:

    • Public Health
    • Forensic Medicine
    • Addiction Medicine

    Background:

    • Substance use disorders (SUDs) pose significant health risks.
    • Immigration detention settings may present unique challenges for SUD management.

    Purpose of the Study:

    • To assess documented substance use indicators and the role of SUDs in deaths within US Immigration and Customs Enforcement (ICE) custody.
    • To identify potential gaps in screening, diagnosis, and treatment of SUDs in this population.

    Main Methods:

    • Retrospective cross-sectional review of 69 publicly available ICE Detainee Death Reviews (DDRs) from April 2018 to May 2025.
    • Analysis by medically licensed reviewers for substance use indicators, clinical care, and emergency response.
    • Inclusion of demographic, psychiatric, and healthcare access variables.

    Main Results:

    • Among 27 deaths with probable substance use history, none had documented SUD diagnosis, referral, or treatment.
    • Nine deaths (33.3%) resulted from complications of untreated substance use, including opioid and alcohol withdrawal.
    • Over half of these cases showed delayed emergency response; formal capacity assessments were not documented.

    Conclusions:

    • Significant gaps exist in the documented identification and treatment of SUD among individuals who died in ICE custody.
    • Standardized behavioral health protocols and timely emergency response are crucial.
    • Increased transparency is needed to address substance-related risks in immigration detention.