An investigation of fentanyl and methamphetamine use among first-time arrestees from 25 county jails across the U.S. in 2023.

Widespread use of fentanyl in combination with methamphetamine in carceral settings presents unique health risks and public health challenges. To contribute to continued efforts to understand drug use among first-time arrestees, this study characterizes the nature and extent of urine drug screenings (UDS) positive for fentanyl and/or methamphetamine among first-time arrestees receiving healthcare in 25 jails across the U.S. This study used the same data source, data extraction, sample selection, and UDS variables as those reported by Schumacher et al. (2025) and a similar data analytic strategy which included 81,842 arrestees with a UDS or 28.8% of total arrestees (283,884). Among first-time arrestees with complete results (43,553), 32,561 or 74.8% of arrestees tested positive for any drug and among those, 14,426 (44.3%) were positive for fentanyl and/or methamphetamine. Of those, 59.8% and 11.5% were only positive for methamphetamine or fentanyl, respectively, while 28.7% were positive for both. Demographically, individuals testing positive for both fentanyl and methamphetamine were predominantly white young adults (aged 20-39), with similar co-occurrence patterns in males and females. Fentanyl alone was more common in southern and midwestern jails and mega-sized jails, methamphetamine was more common in medium-large and southern jails, and their co-occurrence was most common in western and large jails. Approximately 97.5% of first-time arrestees tested positive for two or more drugs, with individuals testing positive for five or more drugs significantly more likely to test positive for both fentanyl and methamphetamine. This study highlights the significant prevalence of methamphetamine and/or fentanyl use among first-time arrestees, underscoring the urgent need for targeted interventions, improved in-jail substance use treatment, and post-release support to mitigate overdose risks and enhance public health outcomes.