I n speaking with police about preventing overdose, the officers’ common refrain is “We aren’t going to arrest our way out of this” (https://bit.ly/3O3d4Vc). And among public health practitioners, there is weariness that our best efforts have not yet stemmed the tide of overdose deaths. In this context, an article in this issue of AJPH lends credence to law enforcement’s mantra and provides health policymakers with evidence to take bolder action. In this issue of AJPH, Ray et al. (p. 750) explored whether overdose increased or decreased in proximity to drug arrests in Indianapolis, Indiana. They found that within a six-minute walk (500 m) of each drug arrest, opioid overdose deaths doubled.
Elevated fatal and nonfatal opioid overdoses were sustained over one, two, and three weeks. What could explain this remarkable finding? In an editorial in this issue of AJPH, Dietze (p. 745), drawing on experience from Australia, explores possible causal mechanisms related to interrupted opioid tolerance, which leaves people at higher risk for overdose when the same quantity is used after a period of abstinence. Correspondingly, Ray et al. did not find the same association with stimulants, which are not subject to the same discontinuation immediate overdose risk.
Conceptualizing stimulants as a control group, and employing a counterfactual modeling strategy, provides a counterpoint to criticism that increasing drug arrests are only a parallel association with increasing overdoses. Alternatively, interruption of supply drives people to new drug suppliers, who may have levels of active ingredient to which the individual is unaccustomed. Further investigations are needed to evaluate these ecological findings in causal inference frameworks.
Because of the importance of the findings and specialized methods, AJPH put the article through an extensive peer review process, with eight independent reviewers, who included legal scholars, epidemiologists, and geospatial statisticians, as well as internal statistical and methodological reviews by editors. The supplementary material includes additional data that were requested during review, including quantities of drugs seized.
