Drug-induced homicide laws in the US: current trends, stakeholder opinions, and public health impacts

Today, more than 100,000 people die from overdose every year in the United States. Despite an abundance of proven and under-utilized public health strategies for preventing overdose, many US jurisdictions have pursued harsher criminal punishments for drug-related crimes, especially following a fatal overdose. State-level drug-induced homicide (DIH) laws create specific criminal liability for individuals who sell or deliver drugs that subsequently cause or contribute to the death of another person. Although most state DIH laws were first enacted in the 1980’s and 1990’s, their use has exponentially increased across the United States over the past few years, due to both a resurgence in prosecution under existing laws and the enactment of new state laws. The impact of DIH laws and prosecutions on overdose deaths has not been systematically evaluated; however, a growing body of evidence suggests that they may increase community risk in a number of ways. This presentation shares findings from a community-engaged literature review exploring the impacts of DIH laws on community wellness in Haywood County, a rural region of North Carolina where what is arguably the most high-profile DIH prosecution in the state was recently tried. First, we conducted a scoping review of formal and informal literature on the implementation and impacts of DIH laws in the United States. That scoping review identified robust evidence that DIH laws significantly deter community members from calling 911 during an overdose emergency, limited evidence that DIH laws deter neither drug use nor drug distribution, and emerging evidence of extreme racial bias in the selection of overdose events deemed appropriate for prosecutions. Second, we presented the findings of that scoping review to key stakeholders (including people who use drugs, harm reduction professionals, parents who have lost adult children to fatal overdose, and professionals working within the criminal justice system) and held focus groups to discuss the review findings, explore stakeholder perceptions of the accuracy and completeness of those findings, and to identify additional impacts experienced, perceived, or otherwise believed to exist by those stakeholders that were not found in formal or informal literature. People who use drugs discussed personal experiences with police in a policy environment where overdose can be tried as murder, adding depth to the review findings suggesting DIH laws drive excess harm. Parents who have lost children to overdose--some of whom had advocated for DIH prosecution following their child's death--discussed the moral valence of DIH laws, revealing how ideologically-informed ideas about "justice" can alternately align or conflict with public health-oriented approaches to overdose prevention. This presentation will be of interest to anyone concerned with the social logic(s) of criminalization or who is working to navigate ideological barriers to evidence-based policy.