Abstract
The United States' legal responses to substance use and addiction have led to frequent interactions between people who use drugs (PWUD) and criminal-legal systems. Interactions with policing, courts, detention facilities, and community supervision can shape health risk and disrupt access to services. Behavioral health and harm reduction organizations also frequently experience law enforcement interference on the program level. To better understand this structural determinant of PWUD health, we developed survey measures that assess PWUD's contact with criminal-legal systems across 10 harm reduction studies. Using input from experts and leveraging the National Institutes of Health Research on Interventions for Stability & Engagement network, the survey captures a broad range of legal interactions. The resulting measures enhance comparability across studies, informing policies that address the complex relationship between criminal-legal involvement and health outcomes for PWUD, particularly in overdose prevention efforts.