A discussion of critical errors in a longitudinal study on the deterrent effect of drug‐induced homicide laws on opioid‐related mortality across 92 counties and the District of Columbia in the United States

• Published date: 01 December 2023
• Author: Jennifer J. Carroll,Leah Bevis,Taleed El‐Sabawi,Mary Figgatt,Nabarun Dasgupta,Leo Beletsky,Amy J. Leiberman,Ashleigh Dennis,Corey S. Davis
• Date: 01 December 2023
• DOI: http://doi.org/10.1002/wmh3.570

Received: 26 September 2022

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Revised: 6 December 2022

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Accepted: 1 February 2023

DOI: 10.1002/wmh3.570

RESEARCH ARTICLE

A discussion of critical errors in a longitudinal

study on the deterrent effect of drug‐induced

homicide laws on opioid‐related mortality

across 92 counties and the District of

Columbia in the United States

Jennifer J. Carroll

1,2

|Leah Bevis

3

|Taleed El‐Sabawi

4,5

|

Mary Figgatt

6,7

|Nabarun Dasgupta

6,7

|Leo Beletsky

8,9

|

Amy J. Leiberman

10

|Ashleigh Dennis

10

|Corey S. Davis

10

1

Department of Sociology and Anthropology,

North Carolina State University, Raleigh,

North Carolina, USA

2

Warren Alpert School of Medicine, Brown

University, Providence, Rhode Island, USA

3

Department of Agricultural, Environmental,

and Development Economics, The Ohio State

University, Columbus, Ohio, USA

4

Florida International University College of

Law, Miami, Florida, USA

5

O'Neill Institute for National and Global

Health Law, Georgetown University,

Washington, District of Columbia, USA

6

Gillings School of Global Public Health,

University of North Carolina at Chapel Hill,

Chapel Hill, North Carolina, USA

7

Injury Prevention Research Center,

University of North Carolina at Chapel Hill,

Chapel Hill, North Carolina, USA

8

Health in Justice Action Lab, Northeastern

University School of Law, Boston,

Massachusetts, USA

9

Bouvé College of Health Sciences at

Northeastern University, Boston,

Massachusetts, USA

10

Harm Reduction Legal Project, Network for

Public Health Law, Edina, Minnesota, USA

Abstract

Drug overdose claimed more than 100,000 lives in the

United States in 2021. Drug‐induced homicide (DIH)

laws create specific criminal liability for individuals who

provide drugs that cause or contribute to the death of

another person. DIH prosecutions in the United States

have increased substantially over the past decade

despite the absence of meaningful evidence of their

individual‐or community‐level impacts. Recently, Lee

et al. analyzed the impact of DIH laws on county‐level

opioid overdose mortality across 92 counties in 10 states

and concluded that DIH laws are associated with

significant reductions in rates of opioid overdose death.

In this commentary, we present evidence demonstrating

that the Lee et al. study is fundamentally flawed.

Specifically, the legal data used by Lee et al. to define

their treatment condition (the presence or absence of a

state‐level DIH law) is incorrect in almost every aspect.

We also describe significant methodological weak-

nesses, including flawed sampling strategies that

resulted in a biased sample of county overdose rates

as well as flawed modeling strategies that cannot

effectively evaluate the hypothesis that DIH laws

negatively impact opioid overdose mortality. More

World Med. & Health Policy. 2023;15:587–612. wileyonlinelibrary.com/journal/wmh3

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587

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which

permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no

modifications or adaptations are made.

© 2023 The Authors. World Medical & Health Policy published by Wiley Periodicals LLC on behalf of Policy Studies Organization.

Correspondence

Jennifer J. Carroll, Department of Sociology

and Anthropology, North Carolina State

University, Raleigh, North Carolina, USA.

Email: jjcarro3@ncsu.edu

research on the individual‐and community‐level impacts

of DIH laws is needed. In the meantime, we advise

policymakers to strengthen state 911 Good Samaritan

laws, as DIH laws appear to erode the efficacy of this

proven overdose‐prevention strategy.

KEYWORDS

deterrence theory, drug‐induced homicide, drug policy, methods,

overdose

Key points

•Drug‐induced homicide laws create specific criminal

liability for individuals who provide drugs that cause or

contribute to the death of another person and are

increasingly used in the United States despite little

evidence of their impact on overdose and other

harms.

•This paper critically evaluates a recent paper that

analyzed the impact of these laws on county‐level

opioid overdose mortality across 92 counties in 10 US

states, concluding that these laws are associated with

reduced opioid overdose deaths.

•We present evidence demonstrating that the previous

paper is fundamentally flawed, detailing serious errors

in the underlying legal research as well as significant

methodological weaknesses that render the results of

the paper unreliable.

•Reliable research on the impact of these laws is

urgently needed. In the meantime, policymakers are

urged to implement policies with robust evidence

demonstrating their overdose‐prevention impacts:

medications for opioid use disorder, naloxone access,

and syringe services programs.

INTRODUCTION

Drug overdose claimed more than 107,000 lives in the United States in 2021 (Ahmad

et al., 2022). Between 2019 and 2020, the national rate of overdose deaths involving

synthetic opioids, such as fentanyl, increased by 5%, representing more than 80% of all

opioid‐related fatalities (US Centers for Disease Control and Prevention, 2022b). Current

evidence suggests that illicitly manufactured fentanyl has become pervasive in the US drug

supply (Jones et al., 2018; Martinez et al., 2021; Park et al., 2018). Though the changing

nature of the drug supply is producing shifts in consumer preference—including some

consumer preference for fentanyl above other opioid products (Ciccarone, 2019)—evidence

overwhelmingly indicates that fentanyl has entered the US drug supply as a result of supply‐

side forces and not in response to clear demand from drug consumers (Carroll et al., 2017;

Hempstead & Yildirim, 2014; Mars et al., 2018). The end result is a drug supply that is more

varied, less predictable, and, as a direct consequence of that unpredictability, deadlier

compared to previous decades.

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