Josiah Rich
· Professor of Medicine and EpidemiologyVerifiedBrown University · Environmental Health Sciences
Active 1976–2026
About
Josiah D. Rich, MD, MPH is a Professor of Medicine and Epidemiology at The Warren Alpert Medical School of Brown University. He has been a practicing Infectious Disease Specialist since 1994, providing clinical care at The Miriam Hospital Immunology Center for over 30 years and working in the Rhode Island Department of Corrections to care for prisoners with HIV infection and other medical issues. His research predominantly focuses on the intersection of infectious diseases, addictions, and incarceration, with over 250 peer-reviewed publications in these areas. Dr. Rich is the Senior Medical Advisor and Co-founder of The Center for Health and Justice Transformation at The Miriam Hospital, advocating for public health policy changes to improve health outcomes for people with addiction, including legal access to sterile syringes and increased drug treatment for incarcerated populations. His expertise includes the treatment and prevention of HIV, infectious diseases, and substance use disorders, especially among incarcerated and addicted individuals. He has served as an expert for organizations such as the National Academy of Sciences and the Institute of Medicine, and has been appointed to Rhode Island's Overdose Prevention and Intervention Task Force to develop strategies to combat opioid overdose and addiction.
Research topics
- Medicine
- Virology
- Pathology
- Intensive care medicine
- Business
- Political Science
- Medical emergency
- Psychology
- Engineering
- Mechanical engineering
- Environmental health
- Psychiatry
- Nursing
- Social psychology
- Pharmacology
- Criminology
- Family medicine
Selected publications
Incarcerated geriatric patients’ experiences of aging and healthcare
Scientific Reports · 2026-03-10
articleOpen accessOlder adults comprise the fastest growing demographic in correctional facilities in the United States. Studies have shown older adults in prison report difficulty accessing healthcare and navigating the prison environment. Little is known about how older adults navigate aging and access healthcare in the jail setting. We sought to explore experiences of older adults incarcerated in a county jail. We conducted semi-structured qualitative interviews with 20 older adults (> 50 years old) who were incarcerated at a local county jail and were referred to the emergency department for acute care needs. Interviews focused on experiences of aging while incarcerated and access to healthcare. We used an inductive approach to code data and identify overarching themes. Participant demographics were representative of the broader jail population demographics. Two major themes emerged. First, participants reported difficulty navigating the jail environment related to aging and unaddressed disabilities. Examples included climbing to use the top bunk of a bunk bed, difficulty grasping objects due to a Parkinsonian tremor, and significant visual impairments. Participants relied on other inmates for assistance with limited systemic accommodations. Second, participants faced numerous challenges when attempting to access healthcare, including lack of clarity around procedures for accessing care and mutual distrust sometimes marking their relationship with medical staff. Participants described difficulty using a digital kiosk system to submit medical requests, and successful healthcare experiences involved an element of serendipity such as advocacy from a sympathetic officer. Despite a constitutional right to healthcare and high rates of medical comorbidities, older prisoners experienced a challenging physical environment in jail and difficulty accessing healthcare. Further work is needed to identify potential age-friendly modifications to the jail environment and improved healthcare delivery.
AEM Education and Training · 2026-04-01 · 1 citations
articleOpen accessBackground: Law enforcement is a common yet complicated presence in the emergency department (ED). Studies have found emergency medicine (EM) attending physicians have varied interactions with and attitudes toward law enforcement. EM resident physicians are in a uniquely formative professional period. However, the experiences and perspectives of EM resident physicians have not been previously explored in depth. Methods: We recruited EM resident physicians from three geopolitically distinct urban academic EDs in the United States to participate in semi-structured interviews regarding their experiences with law enforcement in the ED. We analyzed the transcripts thematically, looking for unifying concepts across institutions and latent meaning. A codebook was created and iteratively refined based on review of transcripts, after which salient themes were developed through ongoing discussions with the research team. Results: Twenty-four resident physicians across three sites participated. Three salient themes emerged from our study: ambiguity of authority between emergency physicians and law enforcement, concerns about the impact of law enforcement presence on patients, and disruptions to the ED team workflow. First, as trainees learning professional norms in the ED, participants reported difficulty navigating situations in which law enforcement attempted to assert authority over patient care. Second, participants perceived negative impacts of law enforcement presence on patients in custody and non-incarcerated patients of color receiving care in the ED. Finally, participants described frequent disruptions to the ED team workflow due to the presence of law enforcement. Participants relied on hospital security, rather than law enforcement, to ensure the safety of patients and staff. Conclusion: Emergency resident physicians described ambiguous boundaries and complex interactions among law enforcement, patients, and themselves in the ED. Although our study found several concerning impacts of law enforcement in the ED, these represent opportunities to clarify roles and responsibilities in the emergency physician-law enforcement relationship and improve patient care. Further research is needed, including eliciting perspectives of law enforcement and patients, particularly those with substance use disorders, trauma, and serious mental illness.
International Journal of Drug Policy · 2026-01-01 · 1 citations
articleOpen access• This is the first study to assess the feasibility of initiating HCV treatment in a U.S. pre-trial jail setting using a low-barrier approach, where patients received a full course of medication upon initiation. • Over half of individuals who initiated treatment in jail completed treatment before release, demonstrating feasibility even in a setting with unpredictable incarceration lengths. • Among those who obtained follow-up HCV RNA labs, cure rates for jail-initiated treatment were 85 %, comparable to those who initiated and completed treatment in prison. • Among individuals released from jail or prison with remaining HCV medications, 65 % ultimately obtained follow-up labs (with the majority of labs occurring during reincarceration events), identifying the need for post-release patient supports. A significant proportion of individuals with hepatitis C virus (HCV) experience incarceration. Jails house individuals who are pre-trial or for short sentences and represent a critical setting to expand HCV treatment access. Low-barrier treatment models may help overcome implementation barriers to initiating treatment in jail settings. In 2021, the Rhode Island Department of Corrections began implementing low-barrier HCV treatment including take-home medications for those released before completing therapy in both a jail (pre-trial) and prison (sentenced) setting. This study aimed to evaluate response to therapy for HCV infection between individuals who initiated treatment in jail versus those who initiated in prison. This study was an observational cohort of people receiving low-barrier HCV treatment initiation between January 2021 and September 2023 at the Rhode Island Department of Corrections. Logistic regression compared individuals who initiated therapy in jail to those initiating in prison. The primary outcome sustained virological response 12 weeks after treatment completion (SVR12). Of 160 individuals who initiated treatment during incarceration, 84 initiated in jail and 76 in prison. SVR12 was similar between individuals who initiated HCV treatment in jail (85%) and those who initiated in prison (86%). There was no statistical difference in likelihood of SVR12 between those initiating in a jail versus a prison in unadjusted bivariate analysis or an adjusted model. Individuals completing treatment in-facility were more likely to achieve SVR12. Jail-based HCV treatment initiation is feasible. However, individuals released with medication face challenges in linkage to care. Improved discharge planning and community linkage are critical to post-release treatment success.
UNC Libraries · 2025-06-12
articleOpen accessThis is the authors’ response to peer-review reports for the paper “SARS-CoV-2 Vaccination Uptake in a Correctional Setting”.
MAb for symptomatic COVID-19 in correctional facilities: an important opportunity
UNC Libraries · 2025-06-04
articleOpen accessContemporary Clinical Trials · 2025-07-15
articleOpen accessSenior authorBACKGROUND: Individuals involved in the criminal legal system represent one of the most disproportionately affected populations in the opioid overdose crisis. Despite evidence of medications for opioid use disorder (MOUD) reducing overdose mortality, illicit opioid use, and recidivism, most correctional facilities do not offer these treatments. Sublocade and Brixadi, two distinct, branded, formulations of extended-release buprenorphine (XR-B), offer a promising approach to improving MOUD treatment adherence and reducing post-release overdose deaths. METHODS: This hybrid pilot study will utilize a partially randomized preference trial (PRPT) design to compare the preliminary effectiveness, feasibility, acceptability and other outcomes between Sublocade and Brixadi initiation. We aim to enroll 60 incarcerated individuals with opioid use disorder who are interested in XR-B and have a scheduled release within 120 days. Participants will choose their preferred injectable treatment or, if ambivalent, be randomly assigned. All participants will receive monthly XR-B injections pre-release and continue for three months post-release, with additional administrative follow-up for another three months. The primary outcome is post-release treatment retention; other outcomes will be assessed using the Proctor taxonomy. Data will be collected using clinical assessments, surveys, and administrative databases. DISCUSSION: This study explores differences in XR-B formulations during the high-risk time of transition out of prison. It combines a hybrid implementation science and preference trial design-two methodologies that can help address the specific challenges of research in carceral environments. By understanding implementation of XR-B in a prison setting, findings can provide valuable insights to guide other facilities in adopting this life-saving treatment.
Substance Use & Misuse · 2025-09-01 · 2 citations
articleOpen accessBACKGROUND: Xylazine is harmful to humans and detected in the United States fentanyl supply and sometimes in stimulants. Awareness of xylazine among people who use stimulants (PWUS) is underexplored. METHODS: In 2023, 59 PWUS in Brockton, Massachusetts, were surveyed about their past 30-day substance use and xylazine awareness. A purposive sub-sample of 21 survey participants completed an in-depth interview, of which 18 discussed xylazine. Chi-square tests assessed global differences in demographics by xylazine awareness. Qualitative data were thematically analyzed by whether participants knew what xylazine was (i.e., xylazine awareness) and past-30-day opioid use - a proxy for xylazine exposure. RESULTS: < 0.05). Interviews indicated limited xylazine knowledge among those only using stimulants. Participants who intended to use fentanyl but experienced deleterious effects of xylazine, including skin wounds and unexpected sedation, realized post-exposure that xylazine was the likely cause of their adverse use experiences. CONCLUSION: Differences in xylazine awareness by substance use, race, and education indicate a need to create literacy-appropriate, culturally relevant xylazine harm reduction messages that are communicated to PWUS by trusted messengers within diverse communities.
BMJ Open · 2025-09-01 · 1 citations
articleOpen accessINTRODUCTION: Hepatitis C virus (HCV) remains a leading cause of infectious disease-related morbidity in the USA, disproportionately affecting people who inject drugs and people who are incarcerated. Despite the availability of highly effective, highly tolerated direct-acting antivirals, treatment uptake in jails remains limited due to short stays, unpredictable release dates and system-level barriers. The original MINMON trial demonstrated that a low barrier 'minimal monitoring"' model can achieve high cure rates in community settings. This study, MINMON-J, aims to adapt and evaluate a modified version of the MINMON model for use in a jail setting, addressing the urgent need for scalable, low-barrier treatment approaches among justice-involved individuals. METHODS AND ANALYSIS: MINMON-J is a single-arm, hybrid effectiveness-implementation pilot study protocol planned to recruit at the Rhode Island Department of Corrections. 40 people who are incarcerated with positive HCV RNA, who are treatment-naïve, without cirrhosis and awaiting trial, will receive 12 weeks of sofosbuvir/velpatasvir with no required lab monitoring during treatment. If released before treatment completion, participants will receive their remaining medication at discharge. Community health workers will provide post-release support. Mixed-methods evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance/Practical, Robust Implementation and Sustainability Model framework. Primary outcomes include feasibility, acceptability and adherence. Data will be collected through administrative records, surveys (Acceptability of Intervention Measure, Feasibility of Intervention Measure, Brief Adherence Rating Scale) and qualitative interviews with participants and other relevant parties. This study was reviewed and approved by the Brown University Health Institutional Review Board (2240400) and the Rhode Island Department of Corrections Medical Research Advisory Group. ETHICS AND DISSEMINATION: This study was reviewed and approved by the Brown University Health Institutional Review Board (2240400) and the Rhode Island Department of Corrections (RIDOC) Medical Research Advisory Group. All participants will provide written informed consent prior to enrolment. People who are incarcerated will be assured that participation is voluntary, will not impact their clinical care and that they may withdraw at any time without penalty. Study procedures follow ethical principles outlined in the Declaration of Helsinki and comply with federal regulations regarding research involving vulnerable populations.Dissemination of findings will include peer-reviewed publications and presentations at national conferences focused on infectious diseases, implementation science and/or correctional health. Lay summaries will be shared with RIDOC leadership and community partners. De-identified data and associated metadata may be archived in a publicly accessible repository in accordance with National Institutes of Health data sharing policies, contingent on final institutional review board approval and participant protections. TRIAL REGISTRATION NUMBER: NCT06953479.
Clinical Infectious Diseases · 2025-09-15
articleOpen accessState-of-the-Art Review: The Intersection of Infectious Diseases and Carceral Medicine
Clinical Infectious Diseases · 2025-09-15
reviewOpen accessMass incarceration is a national epidemic; all clinicians will encounter persons currently incarcerated or with a history of criminal-legal involvement. Infections are highly prevalent in these populations. This review will support clinicians to provide evidence-based infectious diseases treatment with explicit recognition of the interpersonal and structural intricacies in carceral care. Following a criminal-legal system primer, clinicians will have a finer understanding of the psychosocial complexities involved in building provider-patient relationships with those impacted by this system. By recognizing that care delivery can be subject to a potential conflict of interest in supporting both the health interests of persons incarcerated while respecting the unique carceral institution regulations in place to protect carceral staff, clinicians will navigate the concept of "dual loyalty." With this, in conjunction with supporting patient autonomy in treatment decisions and providing infection-prevention counseling and treatment, clinicians can create a therapeutic patient alliance and reduce health disparities.
Recent grants
HIV and Other Infectious Consequences of Substance Use
NIH · $9.0M · 2001–2028
Core C: Translational and Transformative Research
NIH · $37.8M · 2018–2028
NIH · $753k · 2002
A Randomized Trial of Continued Methadone Maintenance vs. Detoxification in Jail
NIH · $2.5M · 2009–2016
NIH · $663k · 2017–2020
Frequent coauthors
- 333 shared
Traci C. Green
Rhode Island Hospital
- 210 shared
Timothy Flanigan
Providence College
- 165 shared
Michelle McKenzie
Rhode Island Hospital
- 142 shared
Nickolas Zaller
University of Arkansas for Medical Sciences
- 117 shared
Alexandria Macmadu
Brown University
- 104 shared
Jennifer G. Clarke
Brown University
- 103 shared
Eleftherios Mylonakis
Houston Methodist
- 102 shared
J. Edward Berk
Brown University
Education
M.D.
The Warren Alpert Medical School of Brown University
Other
The Warren Alpert Medical School of Brown University
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