Substance Use
US state fentanyl laws and opioid overdose mortality trends Erin Annunziato* Erin Annunziato Annunziato Annunziato Annunziato Annunziato Columbia University
Aims: As of June 2023, 43 states enacted or introduced laws increasing penalties for fentanyl distribution to reduce overdose mortality. We examined the impact of fentanyl laws on overdose trends.
Methods: The outcome was state-month opioid (ICD-10 T40.0-T40.4, T40.6) overdose deaths from 2013-2024 Multiple Cause of Death CDC Data. The exposure was fentanyl law enactment date from Legislative Analysis and Public Policy Association’s “Fentanyl-specific criminal provisions: Summary of state laws” dataset. Interrupted time series analyses with linear regression tested overdose changes following enactment lagged 1, 2, and 3 years.
Results: From 2016-2023, 23 states enacted fentanyl laws as opioid overdose mortality rates increased from 2016-2021 and declined after 2022. Among 14 states that enacted laws before 2022, 1-year lag models showed overdoses increased significantly in 7 states immediately after enactment and no significant changes in 10 states. Significant increases did not persist over time post-enactment. For example, Florida’s 2017 law was associated with 117 (95% CI=64, 169) more overdoses immediately after enactment, with overdoses predicted to decrease by 6.4 per month post-enactment. Among 9 states that enacted laws after 2022, overdoses significantly decreased immediately after enactment in 5 states that enacted laws in 2023 after overdose deaths had started declining. Models testing 2 and 3 year lags showed almost all pre-2022 laws were associated with immediate increases in overdoses.
Conclusions: Results do not provide evidence that fentanyl criminalization caused overdose mortality declines. Pre-2022 fentanyl laws were associated with increased overdoses 1, 2, and 3 years after enactment. Post-2022 fentanyl laws were associated with decreased overdoses, but declining overdose trends preceded fentanyl law enactment. Understanding the impact of fentanyl laws is necessary for policymakers considering strategies to sustain overdose mortality declines.