Dataset Information

Assessing the effectiveness of problem-solving courts on the reduction of overdose deaths in the United States: A difference-in-difference study.

ABSTRACT:

Background

Criminal justice-involved populations are disproportionately more likely to have an active substance use disorder (SUD) and experience a fatal overdose. One way the criminal justice system connects individuals with SUDs to treatment is through problem-solving drug courts designed to divert offenders into treatment. The aim of this study is to assess the effect of drug court implementation on drug overdoses in U.S counties.

Methods

A difference-in-difference analysis of publicly available data on problem-solving courts and monthly, county-level overdose death data, was completed to understand the difference in number of overdose deaths per county per year for counties with a drug court and those without. The time frame was 2000-2012, which included 630 courts serving 221 counties.

Results

There was a significant effect of drug courts in reducing county overdose mortality by 2.924 (95% CI: -3.478 - -2.370), after controlling for annual trends. Additionally, having a higher number of outpatient SUD providers in the county (coefficient 0.092, 95% CI: 0.032 - 0.152), a higher proportion of uninsured population (coefficient 0.062, 95% CI: 0.052-0.072), and being in the Northeast region (coefficient 0.51, 95% CI: 0.313 - 0.707), was associated with higher county overdose mortality.

Conclusions

When considering responses to SUDs, our findings point towards drug courts as a useful component of a compendium of strategies to address opioid fatalities. Policymakers and local leaders who wish to engage the criminal justice system in efforts to address the opioid epidemic should be aware of this relationship.

SUBMITTER: Lindenfeld Z

PROVIDER: S-EPMC9948897 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Assessing the effectiveness of problem-solving courts on the reduction of overdose deaths in the United States: A difference-in-difference study.

Lindenfeld Zoe Z Kim Sooyoung S Chang Ji Eun JE

Drug and alcohol dependence reports 20220812

<h4>Background</h4>Criminal justice-involved populations are disproportionately more likely to have an active substance use disorder (SUD) and experience a fatal overdose. One way the criminal justice system connects individuals with SUDs to treatment is through problem-solving drug courts designed to divert offenders into treatment. The aim of this study is to assess the effect of drug court implementation on drug overdoses in U.S counties.<h4>Methods</h4>A difference-in-difference analysis of ...[more]

PMID: 36846580

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Project description:The US opioid overdose epidemic has been a major public health concern in recent decades. There has been increasing recognition that its etiology is rooted in part in the social contexts that mediate substance use and access; however, reliable statistical measures of social influence are lacking in the literature. We use Facebook's social connectedness index (SCI) as a proxy for real-life social networks across diverse spatial regions that help quantify social connectivity across different spatial units. This is a measure of the relative probability of connections between localities that offers a unique lens to understand the effects of social networks on health outcomes. We use SCI to develop a variable, called "deaths in social proximity", to measure the influence of social networks on opioid overdose deaths (OODs) in US counties. Our results show a statistically significant effect size for deaths in social proximity on OODs in counties in the United States, controlling for spatial proximity, as well as demographic and clinical covariates. The effect size of standardized deaths in social proximity in our cluster-robust linear regression model indicates that a one-standard-deviation increase, equal to 11.70 more deaths per 100,000 population in the social proximity of ego counties in the contiguous United States, is associated with thirteen more deaths per 100, 000 population in ego counties. To further validate our findings, we performed a series of robustness checks using a network autocorrelation model to account for social network effects, a spatial autocorrelation model to capture spatial dependencies, and a two-way fixed-effect model to control for unobserved spatial and time-invariant characteristics. These checks consistently provide statistically robust evidence of positive social influence on OODs in US counties. Our analysis provides a pathway for public health interventions informed by social network structures. The statistical robustness of our primary variable of interest, deaths in social proximity, supports the hypothesis of a social network effect on OODs. Using agent-based modeling (ABM) to simulate social networks can offer an effective method to design interventions that incorporate the dynamics of social networks for maximum impact.

Project description:In this paper we argue that a synthesis of findings across the various sub-areas of research in complex problem solving and consequently progress in theory building is hampered by an insufficient differentiation of complexity and difficulty. In the proposed framework of person, task, and situation (PTS), complexity is conceptualized as a quality that is determined by the cognitive demands that the characteristics of the task and the situation impose. Difficulty represents the quantifiable level of a person's success in dealing with such demands. We use the well-documented "semantic effect" as an exemplar for testing some of the conceptual assumptions derived from the PTS framework. We demonstrate how a differentiation between complexity and difficulty can help take beyond a potentially too narrowly defined psychometric perspective and subsequently gain a better understanding of the cognitive mechanisms behind this effect. In an empirical study a total of 240 university students were randomly allocated to one of four conditions. The four conditions resulted from contrasting the semanticity level of the variable labels used in the CPS system (high vs. low) and two instruction conditions for how to explore the CPS system's causal structure (starting with the assumption that all relationships between variables existed vs. starting with the assumption that none of the relationships existed). The variation in the instruction aimed at inducing knowledge acquisition processes of either (1) systematic elimination of presumptions, or (2) systematic compilation of a mental representation of the causal structure underpinning the system. Results indicate that (a) it is more complex to adopt a "blank slate" perspective under high semanticity as it requires processes of inhibiting prior assumptions, and (b) it seems more difficult to employ a systematic heuristic when testing against presumptions. In combination, situational characteristics, such as the semanticity of variable labels, have the potential to trigger qualitatively different tasks. Failing to differentiate between 'task' and 'situation' as independent sources of complexity and treating complexity and difficulty synonymously threaten the validity of performance scores obtained in CPS research.

Project description:Background and aimsIt is widely believed that the 2018 decline in overdose deaths in the United States was attributable to a range of public health interventions, however, this decline also coincided with the regulation and decline in use of potent fentanyl analogs, especially carfentanil. The aim of this study was to investigate the association between overdose deaths and carfentanil availability in the United States.DesignSecondary analysis of drug overdose deaths from the Center for Disease Control and Prevention (CDC) and carfentanil exhibit data from drug seizures submitted to drug crime labs and published by the Drug Enforcement Administration (DEA). Trends in overdose deaths were compared in states with high carfentanil exhibits with states with low or no carfentanil exhibits.SettingUnited States.ParticipantsA total of 1 035 923 drug overdose death records in the United States from 1979 through 2019 were studied.MeasurementsThe outcomes studied were number of overdose deaths and mortality rates by state.FindingsDrug overdose deaths have been closely tracked along an exponential curve. The years 2016 and 2017 witnessed a hyper-exponential surge with increases in overdose deaths of 11 228 (+21.4%) and 6605 (+10.4%), respectively. Subsequently in 2018, drug overdose deaths declined by -2870 (-4.1%). This rise and then fall coincided with a surge and then decline in carfentanil drug seizure exhibits during these same years: 0 (2015), 1292 (2016), 5857 (2017) and 804 (2018). The majority of carfentanil exhibits were localized to a few states. The 2018 decline in overdose deaths in the top five states with the greatest spike in carfentanil exhibits in 2017 (Ohio, Florida, Pennsylvania, Kentucky and Michigan) was 2848, which accounted for nearly all of the total US decline.ConclusionsThe 2016-2017 acceleration and then 2018 decline in drug overdose deaths in the United States was associated with the sudden rise and then fall of carfentanil availability. Given the regional variation, carfentanil's decreased availability may have contributed to the reduction in overdose deaths in 2018.

Project description:ImportanceDeaths due to opioid overdose have tripled in the last decade. Efforts to curb this trend have focused on restricting the prescription opioid supply; however, the near-term effects of such efforts are unknown.ObjectiveTo project effects of interventions to lower prescription opioid misuse on opioid overdose deaths from 2016 to 2025.Design, setting, and participantsThis system dynamics (mathematical) model of the US opioid epidemic projected outcomes of simulated individuals who engage in nonmedical prescription or illicit opioid use from 2016 to 2025. The analysis was performed in 2018 by retrospectively calibrating the model from 2002 to 2015 data from the National Survey on Drug Use and Health and the Centers for Disease Control and Prevention.InterventionsComparison of interventions that would lower the incidence of prescription opioid misuse from 2016 to 2025 based on historical trends (a 7.5% reduction per year) and 50% faster than historical trends (an 11.3% reduction per year), vs a circumstance in which the incidence of misuse remained constant after 2015.Main outcomes and measuresOpioid overdose deaths from prescription and illicit opioids from 2016 to 2025 under each intervention.ResultsUnder the status quo, the annual number of opioid overdose deaths is projected to increase from 33 100 in 2015 to 81 700 (95% uncertainty interval [UI], 63 600-101 700) in 2025 (a 147% increase from 2015). From 2016 to 2025, 700 400 (95% UI, 590 200-817 100) individuals in the United States are projected to die from opioid overdose, with 80% of the deaths attributable to illicit opioids. The number of individuals using illicit opioids is projected to increase by 61%-from 0.93 million (95% UI, 0.83-1.03 million) in 2015 to 1.50 million (95% UI, 0.98-2.22 million) by 2025. Across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3.0% to 5.3%.Conclusions and relevanceThis study's findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.

Project description:Importance:The use of benzodiazepines or alcohol together with opioids increases overdose risk, but characterization of co-involvement by predominant opioid subtype is incomplete to date. Understanding the use of respiratory depressants in opioid overdose deaths (OODs) is important for prevention efforts and policy making. Objective:To assess the prevalence and number of alcohol- or benzodiazepine-involved OODs by opioid subtypes in the United States from 1999 to 2017. Design and Setting:This repeated cross-sectional analysis used data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database of all opioid-involved poisoning deaths from January 1, 1999, to December 31, 2017, for the United States. State-level binge drinking prevalence rates for 2015 to 2017 were obtained from the Behavior Risk Factor Surveillance System of the Centers for Disease Control and Prevention, and benzodiazepine prescribing rates for 2012 (most recent available data) were obtained from IMS Health, a commercial database. Data were analyzed from July 10, 2018, to May 16, 2019. Main Outcomes and Measures:Prevalence of alcohol or benzodiazepine co-involvement for all OODs and by opioid subtype, nationally and by state. Results:From 1999 to 2017, 399 230 poisoning deaths involved opioids, of which 263 601 (66.0%) were male, and 204 560 (51.2%) were aged 35 to 54 years. Alcohol co-involvement for all opioid overdose deaths increased nonlinearly from 12.4% in 1999 to 14.7% in 2017. By opioid subtype, deaths involving heroin and synthetic opioids (eg, fentanyl; excluding methadone) had the highest alcohol co-involvement at 15.5% and 14.9%, respectively, in 2017. Benzodiazepine co-involvement in all OODs increased nonlinearly from 8.7% in 1999 to 21.0% in 2017. Benzodiazepines were present in 33.1% of prescription OODs and 17.1% of synthetic OODs in 2017. State-level rates of binge drinking were significantly correlated with alcohol co-involvement in all OODs (r = 0.34; P = .02). State benzodiazepine prescribing rates were significantly correlated with benzodiazepine co-involvement in all OODs (r = 0.57; P < .001). Conclusions and Relevance:This study found that alcohol and benzodiazepine co-involvement in opioid-involved overdose deaths was common, varied by opioid subtype, and was associated with state-level binge drinking and benzodiazepine prescribing rates. These results may inform state policy initiatives in harm reduction and overdose prevention efforts.

Dataset Information

Assessing the effectiveness of problem-solving courts on the reduction of overdose deaths in the United States: A difference-in-difference study.

Background

Methods

Results

Conclusions

Publications

Assessing the effectiveness of problem-solving courts on the reduction of overdose deaths in the United States: A difference-in-difference study.

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