Assessing the effectiveness of problem-solving courts on the reduction of overdose deaths in the United States: A difference-in-difference study.

Background: Criminal justice-involved populations are disproportionately more likely to have an active substance use disorder (SUD) and experience a fatal overdose. One way the criminal justice system connects individuals with SUDs to treatment is through problem-solving drug courts designed to divert offenders into treatment. The aim of this study is to assess the effect of drug court implementation on drug overdoses in U.S counties. Methods: A difference-in-difference analysis of publicly available data on problem-solving courts and monthly, county-level overdose death data, was completed to understand the difference in number of overdose deaths per county per year for counties with a drug court and those without. The time frame was 2000-2012, which included 630 courts serving 221 counties. Results: There was a significant effect of drug courts in reducing county overdose mortality by 2.924 (95% CI: -3.478 - -2.370), after controlling for annual trends. Additionally, having a higher number of outpatient SUD providers in the county (coefficient 0.092, 95% CI: 0.032 - 0.152), a higher proportion of uninsured population (coefficient 0.062, 95% CI: 0.052-0.072), and being in the Northeast region (coefficient 0.51, 95% CI: 0.313 - 0.707), was associated with higher county overdose mortality. Conclusions: When considering responses to SUDs, our findings point towards drug courts as a useful component of a compendium of strategies to address opioid fatalities. Policymakers and local leaders who wish to engage the criminal justice system in efforts to address the opioid epidemic should be aware of this relationship.