New report examines "The Opioid Epidemic and Homicide"

The Harry Frank Guggenheim Foundation has released this notable new report titled "The Opioid Epidemic and Homicide" authored by Joel Wallman, Richard Rosenfeld, and Randolph Roth. Here is the 20-page report's executive summary:

The twenty-five-year epidemic of opioid misuse in the United States has taken at least 750,000 lives through overdose. We undertook to learn whether this toll might have been accompanied by an increase in violence resulting from growth in the illicit opioid market, which, like most illicit drug markets, includes a risk of violence due to conflicts among sellers and between sellers and buyers.  We found that increases in activity in this market were associated with — and arguably caused — increased levels of homicide.

Using county opioid overdose rates as a measure of levels of transactions in the illicit market, we looked for an association between those rates and county homicide rates between 1999 and 2015.  As the epidemic has been especially intense in the White U.S. population, we conducted separate analyses for the White and Black populations. We also compared Appalachian counties to the rest of the country, as Appalachia has been particularly hard hit by the crisis.

In the nation as a whole, White overdose rates in this period were 28 percent higher than Black rates.  The growth in overdose rates differed markedly between the two groups: 34 percent for Blacks and 120 percent for Whites.  Black overdose rates did not differ between Appalachian and non-Appalachian counties.  The White overdose rate, however, was both considerably higher in Appalachia than elsewhere (23.5 vs. 19 per 100,000) and much higher than the Black Appalachian rate (14.5).  The growth in overdose rates was much higher for both groups within Appalachia than elsewhere: 58 percent vs. 32 percent for Blacks and 146 percent vs. 115 percent for Whites.

Despite this growth in overdose rates during the period, homicide rates declined for both groups and in both Appalachian and non-Appalachian counties.  This means that the aggregate effect of all the factors influencing U.S. homicide rates was a beneficial one.  However, to discern the independent association (if any) between changes in activity in the illicit-opioid market and changes in homicide rates, we conducted a series of multiple regression analyses.  We found a positive association between overdoses and homicides in both racial groups and both within and without Appalachia.  Holding constant several other variables known to be associated with homicide rates, we found growth in overdose among Whites in this period was associated with a 9-percent increase in homicide across all counties and a 19-percent increase within Appalachia.  The equivalent figures for Blacks were 3.5 and 16.

Assuming these associations reflect a causal relationship, we conclude that this growth in illicit opioid activity exerted upward pressure on rates of violence; were it not for the violence associated with the opioid market, the national drop in killings would have been greater.  The finding of another harm wrought by the opioid epidemic provides another reason to pursue vigorous public-health efforts, with a strong emphasis on treatment, to stem the epidemic.