Discretion and Variation in Drug‑Related Federally Assisted Housing Policies Across Public Housing Authorities in Overdose-Impacted Jurisdictions.

Public housing authorities (PHAs) apply federal drug-related eligibility and termination criteria but retain discretion in specifying key provisions. We reviewed 36 written policy documents from 19 PHAs serving overdose-impacted metropolitan and micropolitan jurisdictions in 18 states and Washington, D.C. Jurisdictions were selected purposively based on local overdose rates and metropolitan or micropolitan classification. We coded six components spanning eviction and criminal activity lookback periods; definitions of current drug use; termination standards; and whether substance use disorder (SUD) treatment could mitigate exclusions and termination decisions. Criminal activity lookback periods ranged from 18 months to 10 years, and definitions of current drug use and termination criteria varied or were undefined. Most policies permitted SUD treatment as a mitigating factor, but some did not. Variation in written policies within a shared federal framework may contribute to structural barriers to stable housing for people with SUD, with implications for recovery and overdose prevention.