drugs

The Effects of Drug Courts on Recidivism

IMPACT:

LOCUS:

ORIGIN: Peer-Reviewed Systematic Review

Author(s): NPO Staff

The Problem:

Illicit drug use is a well-recognized public health problem. Overdose and other less acute harms are associated with the non-medical use of controlled substances. The policy response to illicit drug use in the United States has historically focused on a punitive model. Resulting high rates of incarceration have placed large numbers of non-violent offenders into correctional facilities. Life in prison exposes inmates to numerous health risks. High incarceration rates also strain families and communities particularly in areas already suffering from harms associated with low socioeconomic status. As a result, both illicit drug use and the prevailing policy response aimed at reducing it are sources of harm to population health.   Reducing incarceration for non-violent crime – the majority of which involves use and trafficking of small amounts of illicit drugs – is widely recognized as an important policy objective. Congressional Research Service, GAO: Drug Courts.

The Law:

In response to growing evidence of the public health burden of over-criminalization and the failure of the traditional punitive approach to stem illicit drug activity, in the late 1980s, states and localities started experimenting with models aimed more at rehabilitation than retribution. Representing one form of what is often referred to as therapeutic justice, drugs courts emerged as a new model for dealing with minor drug-related crimes. These specialized courts aim to divert convicted drug-offenders into treatment rather than incarceration. Between 1989 and 2009, well over 2000 drugs courts were created in the United States. U.S. Department of Justice.  Many drug courts are created though judicial rulemaking. Examples of laws creating drug courts can be found in Mississippi (M.S. Code § 9-23 et seq) and Illinois (730 ILCS 166.1 et seq).

The Evidence:

Wilson, et al., systematically reviewed studies assessing the effect of drug courts on recidivism. David B. Wilson, Ojmarrh Mitchell, And Doris L. Mackenzie, A systematic review of drug court effects on recidivism, Journal of Experimental Criminology (2006) 2:459Y487. The reviewers identified fifty studies that fit their inclusion criteria. Using meta-analytic techniques, the reviewers combined odds-ratios across the studies in a random effects model.  The overall summary odds ratio – which was statistically significant – was 1.62. The reviewers’ interpretation of the results from the summary statistic and other correlates in the regression was that recidivism decreased by 26% for offenders in drug courts versus comparison groups. However, methodological weaknesses in the majority of the included studies were noted as a source of caution against this figure. A more conservative estimate of the effect was found when they limited their review to more methodologically sophisticated studies.  Overall, however, the authors view the evidence as sufficient to support the effectiveness of drug courts in reducing recidivism.

The Bottom Line:

According to the authors of a peer-reviewed systematic review, there is sufficient evidence to support the effectiveness drug courts in reducing recidivism among individuals convicted of drug-related offenses.

Categories:
How can public health law support intervention in drug overdoses?

Drug overdose deaths have surpassed traffic fatalities in Washington State and 15 other states. This study will examine the legal intent, implementation and outcomes of a new Washington state law to support intervening in drug overdoses. The law includes a Good Samaritan component that provides legal immunity from drug possession charges for people who overdose or seek aid for another person’s overdose. It also allows the prescribing of an opioid antidote medicine (Naloxone) to drug users and their partners. Evaluation will be conducted on the development of the legislation and the impact of the law on Seattle area heroin users, bystanders, and police during overdoses as well as the impacts on community health outcomes.

Grant Number: 68396

Funding Date: Mon, 11/15/2010

Researching Institution: University of Washington

Researcher: Caleb Banta-Green, Ph.D. M.P.H. M.S.W.; Patrica Kuszler, M.D., J.D.

Results

Summary of Initial Findings

Passage of the “911 Good Samaritan Overdose Law” took five years, keys to passage included:

  • Framing the law as a public health issue, not primarily as a legal issue.
  • The emergence of prescription medicines (e.g. opiate pain medicines) as the drugs involved in a  majority of drug overdoses. This increased the perceived public health risks of overdose and broadened the populations, demographically and geographically, that could be helped by legislative action.
  • Keeping the scope of immunity narrow, just drug possession, was the only way to get support of law enforcement, prosecutors, and some legislators.

First responders’ and opiate users’ experience with overdose included:

  • Opiate overdoses are common---42% of opiate users and 62% of Seattle police reported being present at the scene of a serious opiate overdose in the prior year.  (Almost all opiate users surveyed at syringe exchange used heroin.)
  • Most paramedics had been at an overdose in the prior year and approximately 45 serious opiate  overdose victims (heroin or pharmaceutical) are transported by Seattle medics each month.
  • Police were at the scene of most overdoses for which 911 was called according to drug users and paramedics.
  • Arrests of overdose victims and bystanders were very rare according to drug users, paramedics, and police.

Impacts of Good Samaritan Law on planned behaviors:

  • 88% of opiate users indicated that now that they were aware of the law they would be more likely to call 911 during future overdoses. 
  • 62% of police surveyed said the law would not change their behavior during a future overdose because they would not have made an arrest for possession anyway, 20% were unsure what they would do, and 14% said they would be less likely to make such an arrest.

Information dissemination:

  • Funding for implementation of the law was not included in the legislation and no state agency was assigned responsibility for implementing the law.
  • Information dissemination has involved the limited distribution of written educational materials.
  • The website http://stopoverdose.org appears to be a frequently accessed source of information.

Caleb Banta-Green at the University of Washington

Categories: