Adult Drug Treatment Courts and Their Communities: A Rigorous Examination of Drug Court Impact on Community Overdose Rates and How Social and Structural Determinants of Health Play a Role - With over 100,000 drug overdose deaths annually, substance use disorder (SUD) amounts to a national crisis. Research has demonstrated a connection between public health issues, like SUD, and public safety. Given the community-level impact of the opioid epidemic, especially for fatal overdoses, communities are taking an “all hands on deck” approach to seeking solutions and many have invested in drug treatment courts (DTCs). DTCs explicitly recognize the connection between the criminal legal system and the SUD treatment services system and form a bridge linking individuals involved in the criminal legal system with SUD services in the community. Though DTCs have operated for over 30 years and now serve nearly two-thirds of US counties, covering over three-quarters of the US population, their impact on communities is not well known; this is particularly true for public health outcomes. DTC research to date almost universally pertains to individual-level participant outcomes (e.g., recidivism, drug use), demonstrating effectiveness at only an individual level. The limited published research on community-level outcomes presents conflicting findings and generally lacks rigor. However, more rigorous preliminary studies recently indicated higher levels of drug possession arrests associated with DTCs, but also indicate reductions in serious and violent crimes, possibly indicating a preventative effect – that DTCs might be catching people early in their criminal and substance use careers, preventing escalation to more serious crimes and drug use. Early research also indicates an association between DTCs and lower fatal overdose rates, though lacking the rigorous methods that could make, and quantify, causal connections, particularly concerning the impact structural and social determinants of health have on this relationship. Given the vast public resources devoted to DTCs, and the serious impact they have on people’s lives, it is crucial to know how DTCs affect the communities in which they serve, including both public health outcomes like fatal overdoses. By leveraging multiple existing databases that are longitudinal and geocoded, this R03 aims to address these gaps. The study will apply three separate quasi-experimental methods, using existing data to its full potential, providing vital information needed to effectively address the opioid crisis. Specifically, the study will provide (a) the most robust evaluation of DTC effects on community- level fatal overdoses, (b) the first study to explore how structural and social determinants of health affect this relationship. With the ultimate goal of saving lives, this R03 will provide crucial information for communities deciding how to use opioid settlement funds, and serve as an initial proof-of-concept for a larger program of research to help community-level decision-makers improve effectiveness and efficiency in both the SUD treatment service system and services within the criminal legal system. 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.
