The impact of HB-139 on substance use outcomes: a natural experiment - Project Summary/Abstract Prior research has demonstrated that financial strain arising from criminal justice involvement is associated with food and housing insecurity, increased recidivism, and overdose deaths; however, there is a paucity of evidence informing approaches to avert these outcomes among people with substance use and criminal justice involvement. This study will address this critical knowledge gap by generating causal evidence of the impacts of legislation (House Bill 139; HB-139) eliminating court fees in New Mexico in 2024. Utilizing the policy as a natural experiment, we will compare drug court engagement and state-wide overdose mortality between New Mexico and a synthetic control group to isolate the impacts of removing court fees and surcharges on these outcomes. Through Aim 1, we will conduct scientific legal mapping to characterize state-level court fee policies nationally (1a), generating a sampling frame to identify plausible counterfactual settings against which to compare overdose deaths in New Mexico before (2022-2024) and (2024-2026) after the passage of HB-139. We will then generate a synthetic control state using data from that sampling frame and conduct controlled interrupted time series analyses to estimate the specific impact of the policy intervention on overdose mortality in New Mexico, using CDC fatal overdose data (1b). Through Aim 2, we will utilize data from New Mexico’s unified court system and conduct interrupted time series analysis measuring the impact of this legislation on court debt, drug court enrollment and completion and recidivism among people in the New Mexico criminal justice system (2022-2026). Through Aim 3, we will conduct qualitative in-depth interviews with stakeholders across New Mexico’s policy and criminal justice systems who were involved in developing, passing, and implementing this legislation (N=20, Group 1), and intended policy beneficiaries, i.e., individuals with court debt and intersecting substance use issues (N=15, Group 2), to characterize the scope and implementation of the legislation. We will utilize the EPIS (Exploration, Preparation, Implementation, Sustainment) Implementation Framework to explore inner and outer contextual factors enabling policy adoption, barriers and facilitators to implementation, and effects on drug court participation, court debt burden, and other issues relevant to defendants with substance use. This study is responsive to RFA DA 25 062 through advancement of scientific understanding and production of actionable policy recommendations to address a known driver of cyclical criminal justice involvement and overdose. Findings will provide insights regarding the burden of court fees on NIDA populations of interest and offer causal evidence regarding their elimination on substance use outcomes. In addition, this study’s focus on policy implementation can provide NIDA and state policymakers with guidance about the adaptation or implementation of similar strategies elsewhere. Taken together, study findings will provide critical evidence to inform strategies to mitigate the impacts of criminal justice involvement on individuals experiencing substance use issues in the US. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction.
