About

Leo Beletsky is a Professor in the Department of Public Health and Health Sciences at Bouvé College of Health Sciences, Northeastern University. He holds a JD and MPH and is involved in research and teaching related to public health. His work focuses on issues within public health, with an emphasis on legal and policy aspects that impact health outcomes. As a faculty member, he contributes to the academic community through his expertise in public health law and policy, supporting the education of students in these fields.

Research topics

• Medicine
• Sociology
• Political Science
• Psychiatry
• Nursing
• Medical emergency
• Environmental health
• Criminology
• Internal medicine
• Emergency medicine
• Social psychology
• Law
• Psychology
• Computer Security
• Pharmacology
• Geography
• Demography
• Anesthesia

Selected publications

• Cannabis legalization and cannabis and opioid use in a large, multistate sample of people who inject drugs: A staggered adoption difference-in-differences analysis

  Drug and Alcohol Dependence · 2026-01-24

  articleOpen access
  PublisherOA PDFDOI

• What's Old Is New Again in Addiction Treatment: The Expansion of Involuntary Commitment in the United States.

  PubMed · 2025-06-01

  articleOpen accessSenior author
  PublisherOA PDF

• Policing as a Structural Determinant of Health

  Annual Review of Public Health · 2025-12-09 · 4 citations

  article

  Policing in the United States functions as a structural determinant of health, with direct and collateral impacts that extend well beyond maintaining order and public safety. This review synthesizes recent evidence (from 2015 to 2025) on the relationship between policing and health. Using a rapid evidence assessment, we examine peer-reviewed and gray literature to capture physical, mental, and community-level outcomes, as well as pathways and mechanisms that link policing to health. Findings indicate that police use of force results in significant injury and deaths annually, disproportionately affecting communities of color. Beyond direct effects, policing contributes to chronic stress, trauma, and economic strain across community and occupational ecosystems. These collateral impacts compound existing structural inequities. Despite promising alternatives to police responses, evidence gaps and reliance on cross-sectional studies limit causal inference. Future research should strengthen data systems, focus on causal research, and integrate public health priorities into public safety strategies.

  PublisherDOI

• Occupational stress and substance use-related stigma among criminal attorneys

  Social Science & Medicine · 2025-11-08 · 2 citations

  articleOpen access

  Problematic substance use is a national crisis in the United States. While criminalization of substance use places the criminal legal system (CLS) on the front lines of this crisis, little is known about how this impacts the CLS workforce. From October 2022 to March 2023, informed by the Health Stigma and Discrimination Framework, we conducted qualitative interviews with practicing criminal attorneys using a semi-structured interview guide focused on drivers, facilitators, and practices of substance use-related stigma. Stigma toward individuals with substance use disorders (SUD) has been shown to influence professional behavior, treatment access and outcomes. Inductive and deductive thematic analysis explored experiences of occupational stressors, personal substance use, and attitudes toward defendants in substance use-related cases. Interviews with 17 participants (7 women, 10 men; 88% White; mean years of legal experience: 13.4, standard deviation: 7.8) revealed a demanding work environment characterized by severe pressures, high-volume caseloads, and the pervasive role of substance use in many cases. Occupational stressors diminished CLS attorneys’ empathy towards defendants and minimized their attention to their own behavioral health. CLS work environments normalized substance use among attorneys (i.e., alcohol), fueling challenges faced by professionals and those encountered by defendants. Respondents lacked evidence-based SUD resources, resulting in ineffective case resolution and increased occupational stress. A sense of futility and emotional exhaustion was expressed about defendants with recurrent substance use-related cases. Overall, we found that failure to effectively address substance use-related harms drives occupational stress and stigma among CLS professionals. Further research is necessary to inform CLS-focused interventions. • Burnout is perpetuated by substance use-related cases and attorney coping practices. • Heavy caseloads and scarce resources leave attorneys feeling ineffective and futile. • Work environments foster stigma and harmful attitudes toward defendants. • Attorneys’ “othering” of defendants’ substance use reveals stigma. • Investing in criminal attorneys' well-being ensures equitable legal services.

  PublisherDOI

• Overdose and overwork: First responder burnout and mental health help-seeking in Missouri's overdose crisis

  Drug and Alcohol Dependence · 2025-02-27 · 6 citations

  articleOpen access

  As the overdose crisis continues to spiral, high volume and intensity of drug poisoning calls are impacting first responders’ mental health. This study examined burnout and attitudes towards mental health help-seeking among first responders in Missouri. The study included 3059 participants, of which 76.4 % were law enforcement officers (LEO) and 23.6 % were emergency medical services personnel/firefighters (EMS/FF). Participants mainly comprised of men (80 %), and a majority had witnessed an overdose fatality (53 %). A descriptive analysis and Structured Equation Model (SEM) of field experience, mental health help-seeking, and burnout indicate that [1] emotional exhaustion and depersonalization levels were higher among LEO than EMS/FF (β= 0.25 and β = 0.28, respectively, p < .001), [2] EMS/FF had higher personal accomplishment scores than LEO (β = −0.10, p = .046), [3] higher levels of depersonalization and emotional exhaustion were associated with lower levels of mental health help-seeking (β = 0.27 and β = 0.50, respectively, p < .001), [4] higher levels of personal accomplishment was associated with higher levels of mental health help-seeking (β = −0.37, p < .001), and 5) there was lower burnout among EMS/FF than LEO. This study highlights important differences in burnout within and across first responder professions. Additionally, this study sets the foundation for targeted research to focus on how burnout manifests itself within these individuals, how it affects their work, and how work environments are impacted. Moving forward, research and practice should prioritize exploring how mental-health help seeking influences burnout. • The overdose crisis substantially affects the mental health of first responders. • Law enforcement officers are more susceptible to burnout compared to emergency medical service personnel / firefighters. • A sense of occupational efficacy is correlated with an increased propensity for mental-health help seeking. • Burnout levels vary within and across first responder professions (law enforcement, emergency medical service, firefighter). • This research emphasizes the importance of prioritizing mental health support within the first responder professions.

  PublisherDOI

• Common data elements for criminal legal system involvement for people who use drugs

  Harm Reduction Journal · 2025-12-11

  articleOpen accessSenior author

  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.

  PublisherOA PDFDOI

• Prescription drug monitoring programs increase racial/ethnic inequities in unmet demand for substance use disorder treatment among people who inject drugs. A repeated cross-sectional analysis of people who inject drugs in 19 US metro areas in 2012, 2015, 2018, and 2022

  medRxiv · 2025-06-11

  preprintOpen access

  ABSTRACT Background Evidence indicates that prescription drug monitoring programs (PDMPs) reduce demand for substance use disorder (SUD) treatment among the general population, perhaps by minimizing the risk of SUD onset through limiting access to prescribed opioids. Little is known about PDMP effects on SUD treatment among people who inject drugs (PWID), a population at high overdose risk. Methods Using four waves (2012, 2015, 2018, and 2022) of National HIV Behavioral Surveillance (NHBS), we conducted two-way fixed-effect modelling of associations of state-level “mandated review” PDMP policies and individual-level (1) SUD treatment utilization, and (2) unmet demand for SUD treatment among 24,518 PWID in 13 states. We tested effect modification by race/ethnicity. Results PDMPs were associated with an 8 percentage-point increase in the probability of unmet demand for SUD treatment in the sample as a whole (95% CI: 3.0, 12.0). PDMP implementation was also associated with an increased Black, Indigenous, Latinx, and other people of color (BILPOC) vs. White gap in the probability of unmet demand, from a 3.0 percentage-point gap in non-PDMP states (95% CI: 1.0, 5.0) to a 9 percentage-point gap in PDMP states (95% CI: 7.0, 11.0). Conclusions PDMPs may increase racial/ethnic inequities in SUD treatment access. To strengthen PDMP effectiveness, supply reduction policies must be accompanied by enhanced access to SUD treatment and other services for PWID, particularly among BILPOC PWID.

  PublisherOA PDFDOI

• Missed opportunities: Public health messaging in media coverage of drug seizures

  Public Health in Practice · 2025-03-14

  articleOpen access

  Objective: To examine mainstream media coverage of drug seizures and identify trends in messaging on substance use treatment and other public health responses. Study design: We compiled news reports published January 2022-May 2024 on drug seizures in the United States. Methods: We extracted information on incident trends (including geography, drugs and other items seized, agencies involved, and mentions of substance use treatment-related resources). Results: Only three of 211 articles (1 %) had any mention of substance use treatment or other public health-related resources. Of those three articles, only one provided actionable information linking to resources. Conclusions: Drug seizure-related media coverage is a missed opportunity to prevent drug-related harms. The lack of public health messaging in drug seizure-related media coverage should be rectified by refocusing coverage away from drug enforcement narratives and instead provide guidance towards evidence-based resources and services.

  PublisherDOI

• Implementation of harm reduction strategies in criminal-legal systems: a scoping review of the literature

  Health & Justice · 2025-10-16 · 1 citations

  articleOpen access

  BACKGROUND: Harm reduction is a public health approach that emphasizes strategies to reduce the negative consequences of drug use. Rising overdose deaths in the United States have prompted integration of harm reduction strategies within criminal-legal systems (CLS), which have historically emphasized deterrence. However, the scope and nature of these strategies across the CLS remain poorly understood. METHODS: We conducted a scoping review, in accordance with PRISMA guidelines, to identify harm reduction strategies targeting illicit drug use that have been implemented within CLS settings in the United States. We searched seven databases for peer-reviewed articles published in the last 10 years. Eligible articles reported on implementation of a harm reduction strategy focused on reaching PWUD in a CLS setting. Using the Sequential Intercept Model as a guiding framework, we mapped strategies to law enforcement, initial detention/court hearings, jails and courts, reentry, and community corrections settings. We used DistillerSR to screen articles and abstract data. RESULTS: From 455 records, 99 articles met inclusion criteria, representing 51 discrete instances of harm reduction strategy implementation. Implementation was most common in custody settings (e.g., jails and courts) and frequently included initiation of medication for opioid use disorder, naloxone distribution, and CLS referral/diversion. Fewer instances of implementation were documented in early stage or community-based settings. CLS staff were directly involved in delivering over 75% of the harm reduction strategies, and one-third included partnerships with non-CLS government agencies. Nearly one-third of the strategies were implemented as part of research studies. CONCLUSIONS: Harm reduction strategies have increasingly been integrated into CLS, though unevenly and often with a narrow clinical focus. Expanding harm reduction within CLS will require broader definitions, system-level buy-in, and efforts to align practice with public health evidence.

  PublisherOA PDFDOI

• State Policies Regulating Law Enforcement Access to Prescription Drug Monitoring Program Testosterone Prescription Data

  JAMA · 2024-10-30 · 1 citations

  articleSenior author

  This study identifies state policies authorizing law enforcement access to prescription drug monitoring program data and discusses the characteristics of those policies, particularly in states with laws banning gender-affirming care.

  PublisherDOI

Recent grants

• Police Training to Reduce Occupational Needlesticks and HIV among Substance Users

  NIH · $3.2M · 2015–2021

Frequent coauthors

• Steffanie A. Strathdee

  University of California, San Diego

  238 shared

• Javier Cepeda

  Johns Hopkins University

  196 shared

• Daniela Abramovitz

  University of California, San Diego

  190 shared

• Jaime Arredondo

  British Columbia Centre on Substance Use

  189 shared

• Pieter Baker

  Johns Hopkins University

  175 shared

• Irina Artamónova

  University of California, San Diego

  157 shared

• María Luisa Mittal

  University of California, San Diego

  156 shared

• Mario Morales

  156 shared