Substance Use
Assessing Racial Heterogeneity in the Effects of State-Level Drug Harm Reduction Law Enactments on fatal drug overdose John Pamplin* John Pamplin Pamplin Pamplin Pamplin Pamplin Columbia University
Drug harm reduction laws have been widely enacted to address the overdose crisis, but the specific provisions included in the enactments vary greatly from state to state and may also have different effects on different populations. This study aimed to identify the set of harm reduction law provisions that were associated with the greatest reductions in opioid overdose mortality overall, and for Black people specifically. We calculated monthly fatal overdose rates from 2000-2022 using data from the National Vital Statistics System and linked them with state-level harm reduction law data from the Prescription Drug Abuse Policy System. We estimated difference-in-difference (DID) models to estimate the average 12-month effect of each policy enactment on rates of opioid-involved overdose deaths, weighted across differences in the pre-and co-enacted policy landscape in the12 months before enactment and a 12-month period after. Separate models were built to estimate the effects of enactment 1-12, 13-24, and 25-36 months post enactment. Predicted effects from each set of models were assessed via post-hoc decision tree regressions. This process was repeated, restricting the outcome to opioid-involved overdose among Black people. There were 114 enactments during the observation period. Decision tree regressions found no enactment scenarios that predicted reductions in overall overdose in any of the assessed post-enactment periods. However, preliminary results suggest that enactment scenarios that included NAL dispenser criminal and civil immunity, and that did not include GSL protection from arrest for drug paraphernalia predicted a .09 deaths per 100,000 reduction in Black overdose deaths 25-36 months post enactment (mse = 0.097; sample = 7). Findings suggest that harm reduction laws may have heterogeneous effects across racial groups; however, very few enactments were associate with reduced overdose, and data did not support differences beyond chance.