Does drug decriminalization increase unintentional drug overdose deaths?

Spencer, Noah

doi:10.1016/j.jhealeco.2023.102798

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…Table 2 and eFigure 2 present the results of regression models of decriminalization on overdose mortality with month and state fixed effects. The odd-numbered columns of Table 2 reproduce the overall results of Spencer 2023, 10 showing that statistical models unadjusted for fentanyl exposure produce positive, statistically significant associations between decriminalization and accidental overdose mortality. However, incorporating our changepoint fentanyl exposure variable in the models to assess the study’s sensitivity to this covariate, the estimated effects of drug decriminalization are null in Oregon (p = 0.38), Washington (p = 0.44), and for both states combined (p = 0.96).…”

Section: Resultsmentioning

confidence: 59%

“…As sensitivity checks, we estimated the relationship between decriminalization and overdose mortality (first unadjusted and then adjusted for fentanyl exposure) using alternative causal panel data models that incorporated time-varying covariates: the two-way fixed effects model, the generalized synthetic control method, 22 and interactive fixed effects methods. 22 We then replicated the “difference-in-differences” (two-way fixed effects regression) results in Spencer 2023, 10 which reported decriminalization increased overdose mortality in Oregon, and extended these analyses by incorporating state-level fentanyl exposure as a covariate.…”

Section: Methodsmentioning

confidence: 82%

“…6-month) level between 2008 and 2022. This represents 2 years of post-intervention data, one additional year beyond the analysis period of Spencer 2023 10 and 9 months beyond that of Joshi 2023. 11 Our primary dependent variable consisted of all fatal drug poisonings (i.e., accidents, suicides, homicides, and unknown intent); the corresponding cause of death classifications are listed in the Supplement.…”

Section: Methodsmentioning

confidence: 99%

“…As M110 took effect on February 1, 2021, we conceptualized the treatment period as commencing in the first half of 2021 or, in monthly analyses, as commencing in February 2021. Following previous studies, 10,11 we do not include Washington State in the comparison group because its supreme court effectively decriminalized drug possession for four months between February 25 (when it struck down the state’s drug possession law) and July 25, 2021, when misdemeanor recriminalization took effect.…”

Section: Methodsmentioning

confidence: 99%

“…To date, 2 studies have assessed the impact of M110 on overdose mortality. Spencer concluded M110 “caused 182 additional unintentional drug overdose deaths to occur in Oregon in 2021,” representing a 23% increase, 10 while Joshi et al used a similar analytical approach and did not detect a change in mortality. 11 However, neither study fully accounted for the “third-wave” of the overdose mortality crisis reaching Oregon: the supply-side shock of illicitly manufactured fentanyl, the highly potent synthetic opioid.…”

Section: Introductionmentioning

confidence: 99%

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Drug decriminalization, the introduction of fentanyl to drug markets, and fatal overdose in Oregon

Zoorob,

Park,

Kral

et al. 2024

Preprint

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Importance: With the implementation of Measure 110 (M110), Oregon became the first state in the United States to decriminalize personal possession of all drugs. No analysis of the effect of this law on overdose mortality has fully accounted for the introduction of fentanyl to Oregon's unregulated drug market, a substance known to drive fatal overdose rates. Objective: To evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the timing and spread of fentanyl through Oregon's unregulated drug market. Design, Setting, and Participants: The association between fatal drug overdose and enactment of M110 in Oregon was analyzed using a matrix completion synthetic control method. The synthetic control unit was imputed from the 48 US states and Washington DC that did not decriminalize drugs. The rapid escalation of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogs. A changepoint analysis was used to determine when each state experienced a rapid escalation of fentanyl in its unregulated drug market. Mortality data were obtained from the Centers for Disease Control and Prevention from 2008-2022. Exposures: M110 took effect on February 1, 2021. Main Outcome: Fatal drug overdose rates per half-year. Results: Analysis indicated a rapid escalation of fentanyl in Oregon's unregulated drug supply occurred in the first half of 2021, contemporaneous with the enactment of M110. The crude association between decriminalization and fatal overdose rate per 100,000 per half-year was significant (Tau = 1.83; SE = 0.39; p < 0.001); however, adjusting for the rapid escalation of fentanyl as a confounder, the effect of drug decriminalization on overdose mortality in Oregon was null (Tau = -0.51; SE = 0.36). Sensitivity analyses were consistent with this result. Conclusions and Relevance: After adjusting for the rapid escalation of fentanyl, analysis found no association between M110 and fatal drug overdose rates. Future evaluations of the health effects of drug policies should account for confounding changes in the composition and potency of unregulated drug markets.

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Section: Resultsmentioning

confidence: 59%

Section: Methodsmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drug decriminalization, the introduction of fentanyl to drug markets, and fatal overdose in Oregon

Zoorob,

Park,

Kral

et al. 2024

Preprint

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Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon

Zoorob,

Park,

Kral

et al. 2024

JAMA Netw Open

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ImportanceWith the implementation of Measure 110 (M110) in 2021, Oregon became the first US state to decriminalize small amounts of any drug for personal use. To date, no analysis of the association of this law with overdose mortality has fully accounted for the introduction of fentanyl—a substance that is known to drive fatal overdose—to Oregon’s unregulated drug market.ObjectiveTo evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the rapid spread of fentanyl in Oregon’s unregulated drug market.Design, Setting, and ParticipantsIn this cohort study, the association between fatal overdose and enactment of M110 was analyzed using a matrix completion synthetic control method. The control group consisted of the 48 US states and Washington, DC, all of which did not decriminalize drugs. The rapid spread of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogues. Mortality data were obtained from the Centers for Disease Control and Prevention for January 1, 2008, to December 31, 2022. Data analysis was performed from fall 2023 through spring 2024.ExposuresMeasure 110 took effect in Oregon on February 1, 2021.Main Outcomes and MeasuresThe primary outcome assessed was fatal drug overdose rates per half-year. A changepoint analysis also determined when each state experienced a rapid escalation of fentanyl in its unregulated drug market.ResultsIn this analysis, rapid spread of fentanyl in Oregon’s unregulated drug supply occurred in the first half of 2021, contemporaneous with enactment of M110. A positive crude association was found between drug decriminalization and fatal overdose rate per 100 000 per half year (estimate [SE], 1.83 [0.47]; P &lt; .001). After adjusting for the spread of fentanyl as a confounder, the effect size changed signs (estimate [SE], −0.51 [0.61]; P = .41) and there was no longer an association between decriminalization and overdose mortality in Oregon. Sensitivity analyses were consistent with this result.Conclusions and RelevanceIn this cohort study of fatal drug overdose and the spread of fentanyl through Oregon’s unregulated drug market, no association between M110 and fatal overdose rates was observed. Future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets.

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