Spatial Concentration of Opioid Overdose Deaths in Indianapolis: An Application of the Law of Crime Concentration at Place to a Public Health Epidemic

• Published date: 01 May 2019
• Date: 01 May 2019
• DOI: http://doi.org/10.1177/1043986218803527
• Subject Matter: Articles

https://doi.org/10.1177/1043986218803527

Journal of Contemporary Criminal Justice

2019, Vol. 35(2) 161 –185

© The Author(s) 2018

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DOI: 10.1177/1043986218803527

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Article

Spatial Concentration of

Opioid Overdose Deaths in

Indianapolis: An Application

of the Law of Crime

Concentration at Place to

a Public Health Epidemic

Jeremy G. Carter1, George Mohler1, and Bradley Ray1

Abstract

The law of crime concentration at place has become a criminological axiom and

the foundation for one of the strongest evidence-based policing strategies to date.

Using longitudinal data from three sources, emergency medical service calls, death

toxicology reports from the Marion County (Indiana) Coroner’s Office, and police

crime data, we provide four unique contributions to this literature. First, this study

provides the first spatial concentration estimation of opioid-related deaths. Second,

our findings support the spatial concentration of opioid deaths and the feasibility

of this approach for public health incidents often outside the purview of traditional

policing. Third, we find that opioid overdose death hot spots spatially overlap with

areas of concentrated violence. Finally, we apply a recent method, corrected Gini

coefficient, to best specify low-N incident concentrations and propose a novel

method for improving upon a shortcoming of this approach. Implications for research

and interventions are discussed.

Keywords

crime concentration, opioid overdose concentration, emergency medical services

data, corrected Gini coefficient, low-N events

1Indiana University–Purdue University Indianapolis, IN, USA

Corresponding Author:

Jeremy G. Carter, School of Public and Environmental Affairs, Indiana University–Purdue University

Indianapolis, 801 W. Michigan Street, Indianapolis, IN 46202, USA.

Email: carterjg@iupui.edu

803527CCJXXX10.1177/1043986218803527Journal of Contemporary Criminal JusticeCarter et al.

research-article2018

162 Journal of Contemporary Criminal Justice 35(2)

Rising rates of opioid use in the United States over the past decade have contributed

to the recent opioid epidemic (Manchikanti et al., 2012; Nelson, Juurlink, & Perrone,

2015). While there have been reductions in prescribing rates in recent years, rates of

opioid prescribing remain 3 times higher than in 1999 (Guy et al., 2017). The result

of this recent opioid epidemic has been dramatic increases in deaths due to drug poi-

soning, which quadrupled from 1998 to 2008 (Centers for Disease Control and

Prevention [CDC], 2011). Over a similar time period, hospitalizations for prescrip-

tion opioids increased by 65% (Coben et al., 2010) and accounted for the vast major-

ity (73.8%) of all prescription drug deaths (CDC, 2011) and 40% of all drug poisoning

deaths (Warner, Chen, Makuc, Anderson, & Miniño, 2011). While the opioid epi-

demic was initially fueled, in part, by revised guidelines for the management of

chronic pain (P. R. Wilson et al., 1997), which resulted in massive increases in opioid

prescribing, more recently deaths have shifted from prescription to illicit opioids. In

2016 nearly half (45.9%) of opioid-related deaths contained fentanyl (Jones, Einstein,

& Compton, 2018), an opioid that is 50 to 100 times more potent than morphine

(Algren et al., 2013).

Research demonstrates the bulk of urban crime concentrates within small propor-

tions of micro-places, thus enabling police to identify criminogenic places for inter-

vention (Weisburd, 2015). Recently, this approach has been applied to crime-specific

problems to enable tailored interventions. Moreover, it has become increasingly evi-

dent that persons entering the criminal justice system, as well as victims of crime,

suffer from co-occurring disorders related to mental health and substance abuse, a

concern that is exacerbated within criminogenic places (White & Weisburd, 2018). As

will be discussed in detail to follow, an empirical estimation of crime concentration to

public health concerns holds significant promise to improve policing, meet much-

needed clinician and service demands, and generate positive outcomes for urban com-

munities. The present study leverages multiple data sources to quantify the spatial

concentration of opioid overdose deaths, the extent to which these opioid hot spots

overlap with other crime and drug hot spots, and provides guidance for future crime

concentration research and improved social intervention.

Crime Concentration at Place

For the past 30 years, criminologists have focused on the importance of place in under-

standing crime occurrence and effective interventions to generate crime control bene-

fits. Indeed, there has been voluminous scholarly attention to the empirical

establishment of crime and place that has led to a phenomenon which Weisburd (2015)

coined as the “law of concentration at places” (also see Weisburd, Groff, & Yang,

2012). This law asserts “that for a defined measure of crime at a specific micro-geo-

graphic unit, the concentration of crime will fall within a narrow bandwidth of per-

centages for a defined cumulative proportion of crime” (Weisburd, 2015, p. 133).

Leveraging crime data from cities of various size, Weisburd (2015) established these

bandwidths, which are cumulative proportions of crime, as constricted proportions of

a geography that generate the bulk of urban crime. Specifically, he found that 50% of