Illicit Drug Use Among Justice-Involved Females
Findings from the 2023 National Survey on Drug Use and Health
September 2025
Drug and property crimes are the leading drivers of women’s incarceration. In 2022, 44% of women in prison were serving time for the two offenses, compared to 25% of men.1 Substance use plays a central role: People incarcerated in state prisons are 12 times more likely than adults in the general population to meet criteria for a substance use disorder.2 Women are especially affected: Roughly 70% of women in jail or prison meet criteria for a substance use disorder, compared to 60% of men, and women are more likely than men to report using drugs at the time of their offense (about 50% vs. 40%).3
Most of these data, however, describe people already behind bars. Less is known about substance use among those arrested and booked but still living in the community—people at the “front end” of the system, where prevention, diversion, and treatment may help prevent expensive and often ineffective cycles of arrest, prosecution, and incarceration.
This brief addresses that gap by using national survey data to examine how drug use patterns differ for people with recent justice system involvement. It uses data from the 2023 National Survey on Drug Use and Health (NSDUH), the nation’s primary source of self-reported information on substance use and mental health, to examine patterns of illicit drug use by sex, race, age, and drug type (see the Supplemental Methodology Report for details). The analysis focuses on two groups:
- The full NSDUH sample: U.S. residents ages 12 and older, representing the civilian, non-incarcerated population; and
- A “justice-involved” subsample: U.S. residents ages 12 and older who reported having been arrested and booked at least once in the past year.
As with all surveys, these estimates are based on a sample and are subject to sampling error. Differences described in this brief have been tested for statistical significance, with more detail provided in the main text.
Key Takeaways
- In the general population, males surveyed in 2023 reported higher levels of illicit drug use during the past year than females (10% of males compared to 8% of females when excluding cannabis). But among justice-involved people—those arrested and booked in the past year—females reported higher past-year use (46% of justice-involved females compared to 41% of justice-involved males when excluding cannabis).
- Justice-involved females were more likely than justice-involved males to have used methamphetamine, cocaine, and opioids in the past year; the gaps were especially large for heroin (11% of females compared to 4% of males) and fentanyl (8% of females compared to 2% of males).
- White justice-involved females and females identifying with more than one race were more likely than their male counterparts to report illicit drug use other than cannabis within the past year (58% of White females compared to 49% of White males). Black and Hispanic females reported lower rates of use than men of the same groups, with 18% of Black females, 23% of Black males, 27% of Hispanic females, and 41% of Hispanic males reporting past-year use.
- Younger justice-involved females (aged 12 to 34) reported slightly less past-year illicit drug use (excluding cannabis) than their male counterparts, but females over 35 reported higher use than males. Notably, 60% of females aged 35 to 49 reported use compared to 45% of males in the same age group.
- In large metro and rural areas, justice-involved females were more likely than males to have used illicit drugs (excluding cannabis) in the past year, but that was not the case in small metro areas. In large metro areas, 59% of justice-involved females reported use, compared to 41% of justice-involved males. Half of the justice-involved females in rural areas reported use, compared to 42% of males.
- While NSDUH data cannot explain why these differences occur, prior research suggests that women’s drug use often develops alongside trauma, economic instability, mental health needs, and caregiving pressures. These dynamics may contribute both to the initiation of substance use and to justice system contact, underscoring the need for more focused research on effective prevention and intervention measures at the front end.
Glossary
- Illicit Drug Use: Use of cannabis, cocaine, heroin, hallucinogens, inhalants, and methamphetamine, and the misuse of prescription pain relievers (including fentanyl), tranquilizers, stimulants, and sedatives.
- National Survey on Drug Use and Health Survey (NSDUH): The nation’s primary source of self-reported data on substance use and mental health among people ages 12 and older in the civilian, noninstitutionalized population. Conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA).
- Prescription Drug Misuse: Use of a prescription drug without a prescription, or in greater amounts, more often, or longer than prescribed, or in any way not directed by a doctor.
Illicit Drug Use in the General Population (All Respondents)
The 2023 NSDUH data represent a weighted population of approximately 283.5 million U.S. residents aged 12 and older, 51% of whom were female. These estimates are derived from a nationally representative sample of about 68,000 survey respondents in 2023, including both adolescents and adults.
Lifetime Drug Use is Common Among Both Females and Males in the General Population
In 2023, nearly half of females (48%) and over half of males (54%) surveyed reported ever using any illicit drugs (or misusing a prescription drug) in their lifetime (“lifetime use”), underscoring the prevalence of drug use across both groups (Figure 1). After excluding cannabis, which may not be considered illicit depending on where the respondent lives, a quarter of females (25%) and nearly a third (32%) of males reported lifetime use of other illicit drugs. These between-group (male-female) differences were statistically significant (p < .001).
Figure 1. Lifetime Illicit Drug Use by Sex, All Respondents Ages 12+, 2023
About 1 in 12 Females and 1 in 10 Males Report Using an Illicit Drug in the Past Year, Excluding Cannabis
Among all U.S. residents ages 12 and older in the NSDUH sample, more than a quarter of males (27%) and nearly a quarter of females (23%) reported using an illicit drug in the past year, including cannabis, which may be legal in some jurisdictions (Figure 2). Excluding cannabis, past-year use dropped to 10% for males and 8% for females. Chi-square tests showed that between-group differences were statistically significant (p < .001).
Figure 2. Past 12-Months Illicit Drug Use by Sex, All Respondents Ages 12+, 2023
Males Lead in Most Illicit Drug Categories, Except Fentanyl
In the full NSDUH sample, males reported higher rates of past-year illicit drug use than females across most drug categories, results that were statistically significant (p < .001). (See Figure 3.) Misuse of opioids was similar for both sexes at around 3%, while differences for specific opioid subtypes—including heroin, prescription pain relievers, and fentanyl—were not statistically significant. For both females and males, cannabis remained the most commonly reported drug.
Figure 3. Past 12-Months Illicit Drug Use by Sex and Drug Type, All Respondents Ages 12+, 2023
A Note on Fentanyl: While fentanyl can be legally prescribed for severe pain—typically through patches, lozenges, or injections—the NSDUH measures only misuse. That includes using fentanyl without a prescription or not as prescribed (for example, in larger amounts, more often, or longer than directed).
Illicit Drug Use Similar Across Racial Groups
Excluding cannabis, past-year illicit drug use in the full NSDUH sample was relatively consistent across racial groups. It ranged from 5% among Asian females to 15% among Native American/Alaska Native females, with most groups falling between 9% and 11% (Figure 4). Female–male differences reached statistical significance only among White and Hispanic respondents.
Figure 4. Past 12-Months Illicit Drug Use (Excluding Cannabis) by Sex and Race, All Respondents Ages 12+, 2023
Illicit Drug Use Among People Arrested and Booked in the Past Year
The justice-involved subsample represents a weighted population of approximately 37.2 million U.S. residents aged 12 and older—about 13% of the total NSDUH population—who reported being arrested and booked at least once in the past 12 months. About 30% of them were female. These estimates are based on survey responses from approximately 8,300 respondents in 2023.
Nine in Ten Justice-Involved Females Report Lifetime Illicit Drug Use
Among people who had been arrested and booked in the past year, lifetime illicit drug use was widespread. About nine in ten females (89%) and more than eight in ten males (84%) reported ever using an illicit drug (Figure 5). This between-group difference neared statistical significance (p = .10). After excluding cannabis, which may not be considered illicit depending on where the respondent lives, 64% of justice-involved females and 61% of justice-involved males reported illicit substance use. This difference was not statistically significant.
Figure 5. Lifetime Illicit Drug Use by Sex, Justice-Involved Respondents Ages 12+, 2023
Justice-Involved Females Are More Likely to Have Used an Illicit Drug in the Past Year, With and Without Cannabis
Past-year illicit drug use followed a similar pattern among those arrested and booked in the previous 12 months: 70% of females and 65% of males in this group reported using illicit drugs—including cannabis, which may be legal in some jurisdictions—in the past 12 months (Figure 6). When cannabis was excluded, the share fell to 46% for females and 41% for males. These between-group differences were not statistically significant.
Figure 6. Past 12-Months Illicit Drug Use by Sex, Justice-Involved Respondents Ages 12+, 2023
Justice-Involved Females Lead in Methamphetamine, Cocaine, and Opioid Use
Among people arrested and booked in the past year, females and males reported similar rates of cannabis use (56%) and prescription pain reliever misuse (16%) over the previous 12 months. (See Figure 7.) Justice-involved females reported higher past-year use than their male counterparts across all other major drug types, including methamphetamines (24% vs. 18%), cocaine (21% vs. 13%), and opioids broadly (20% vs. 17%)—although these differences were not statistically significant. Notably, females were nearly three times as likely to report heroin use (11% vs. 4%), a statistically significant gap (p < .05), and four times as likely to report fentanyl misuse (8% vs. 2%), which approached statistical significance (p = .10). Because heroin and fentanyl are included in the broader opioid category in NSDUH, these figures reflect overlapping, not additive, use.
Figure 7. Past 12-Months Illicit Drug Use by Sex and Drug Type, Justice-Involved Respondents Ages 12+, 2023
White Justice-Involved Females Outpace Male Counterparts in Non-Cannabis Illicit Drug Use
Excluding cannabis, past-year illicit drug use among people arrested and booked in the past year varied notably by both race and sex (Figure 8). Among those who identified as White, 58% of females and 49% of males reported using illicit drugs other than cannabis. Rates were lower among Black respondents, with 18% of females and 23% of males reporting use, and higher among Hispanic respondents, at 27% for females and 41% for males. Among Native American/Alaska Native, 50% of females reported past-year use compared to 70% of males, while females identifying with more than one race reported higher rates than males of the same group (23% vs. 18%). White females were the only single-race group more likely than their male counterparts to report non-cannabis illicit drug use over the past year. Data for justice-involved Asian females were not reported due to small sample size (fewer than 500 respondents).
Significance testing was possible only for White, Black, and Hispanic respondents, and none of the female–male differences in these groups reached statistical significance. Because the public NSDUH Data Analysis System is designed for cross-tabulation rather than advanced modeling, results for smaller subgroups should be interpreted with caution.
Figure 8. Past 12-Months Illicit Drug Use (Excluding Cannabis) by Sex and Race, Justice-Involved Respondents Ages 12+, 2023
Justice-Involved Females Over Age 35 Report Higher Drug Use Than Male Counterparts
Within the justice-involved sample, age patterns in survey findings for illicit drug use over the past 12 months show that the gender gap shifts over the life course (Figure 9). In the younger age groups (12 to 34 years old), males reported slightly higher drug use than females. This pattern reversed for those over 35 years old, with females reporting higher drug use than males; this difference was most notable among people between ages 35 and 49, with 60% of females reporting use compared to 45% of males. Statistical testing for these age-by-sex comparisons was not possible in the NSDUH Data Analysis System, so these results should be interpreted as descriptive patterns.
Figure 9. Past 12-Months Illicit Drug Use (Excluding Cannabis) by Sex and Age, Justice-Involved Respondents Ages 12+, 2023
Female Illicit Drug Use Exceeds Use by Males in Largest and Most Rural Communities
Past-year illicit drug use patterns also differed among justice-involved people according to their communities’ level of urbanization (Figure 10). In large metro areas, 59% of females and 41% of males reported use; in non-metro areas, 50% of females and 42% of males reported use. In small metro areas, the pattern reversed, with 29% of females and 39% of males reporting use. These results suggest that the relationship between sex and drug use shifts across community types, with females’ use exceeding males’ in the largest and most rural areas, but not in smaller metropolitan areas. Statistical testing for these age-by-sex comparisons was not possible in the NSDUH Data Analysis System, so these results should be interpreted as descriptive patterns.
Figure 10. Past 12-Months Illicit Drug Use (Excluding Cannabis) by Sex and Level of Urbanization, Justice-Involved Respondents Ages 12+, 2023
Conclusion
Substance use is a major driver of women’s criminal justice involvement, particularly through drug offenses and property crimes committed to support use. National data show that women in custody are more likely than men to meet criteria for a substance use disorder and to report using drugs at the time of their offense. Yet far less is known about substance use among women arrested and booked but still living in the community—a group whose experiences can shed light on opportunities for prevention and early intervention.
This analysis shows that the relationship between sex and substance use shifts markedly for people with recent justice system involvement. While males in the general population report higher past-year illicit drug use than females, the reverse is true for those arrested and booked in the past year. Justice-involved females not only report higher overall use within the past year, but also greater use of most major drug types—including methamphetamine, cocaine, and opioids—with especially large gaps for heroin and fentanyl. Methamphetamine use stands out as a particular concern, given its prevalence among justice-involved females and the absence of an effective medication-assisted treatment comparable to those available for opioid and alcohol use disorders.
Rates of substance use also vary by race, age, and community type, with especially high prevalence for White females, females over 35, and females in large metro or rural areas. Because NSDUH estimates are weighted and account for complex survey design, effective sample sizes can be smaller than raw numbers suggest. As a result, some differences that appear large are not statistically significant.
These data reflect a community sample of people who were arrested, booked, and released within the past year, meaning the patterns observed may differ from those who remained in custody. Because NSDUH does not capture charge type, criminal history, or case outcomes, it is not possible to know how these factors shape who is represented in the survey. Despite such limitations, findings for this group are particularly relevant for prevention, diversion, and treatment strategies, given the individuals’ continued presence in the community. Focusing on people arrested and booked but not incarcerated creates opportunities to prevent further drug use and crime, connect those who need treatment to evidence-based services, and interrupt the cycle of offending and system involvement.
Although the NSDUH data do not explain why these differences occur, prior research has documented that women in the justice system are more likely than men to have experienced trauma, have co-occurring mental health needs, face economic instability, and carry caregiving responsibilities. These circumstances can contribute both to women’s substance use and to their system involvement, while also creating additional barriers to recovery.
Acknowledgements
Stephanie Kennedy produced this report, with support from Carlos Gonzalez, Ernesto Lopez, and other members of the Council on Criminal Justice team.
This report was produced with support from the Ford Foundation, the George Kaiser Family Foundation, the Joan Ganz Cooney & Holly Peterson Fund, The J.B. and M.K. Pritzker Family Foundation, the Ms. Foundation for Women, the Navigation Fund, the National Football League, Charles and Lynn Schusterman Family Philanthropies, and the Tow Foundation. The Commission also receives support from the John D. and Catherine T. MacArthur Foundation, The Just Trust, Southern Company Foundation, and other CCJ general operating contributors.
Suggested Citation
Council on Criminal Justice. (2025). Illicit drug use among justice-involved females: Findings from the 2023 National Survey on Drug Use and Health. https://counciloncj.org/illicit-drug-use-among-justice-involved-females/
Endnotes
1 Carson, E.A., & Kluckow, R. (2023). Prisoners in 2022–statistical tables (NCJ 307149). Bureau of Justice Statistics. https://bjs.ojp.gov/document/p22st.pdf
2 Bronson, J., Stroop, J., Zimmer, S., & Berzofsky, M. (2017). Drug use, dependence, and abuse among state prisoners and jail inmates, 2007-2009 (NCJ 250546). Bureau of Justice Statistics. https://bjs.ojp.gov/content/pub/pdf/dudaspji0709.pdf
3 Bronson et al., 2017.
