The Influence of Public Health Infrastructure on Prosecutorial Responses to the Opioid Crisis

项目摘要 通过本K 01提案中所述的研究和培训，P.I. (Dr. El-Sabawi）将收购 必要的技能，成为一个独立的研究人员谁使用法律的流行病学的方法来研究 并设计以证据为基础的法律和政策，以改善吸毒者的健康。 美国各地的过量死亡人数激增，有40个州报告说， 截止到2022年5月。一些检察官对当地的吸毒过量危机做出了回应， 谁分发的药物，造成过量死亡与杀人（药物引起的杀人）（DIH），导致 自2011年以来，国家人权机构的起诉急剧增加。此前的研究表明， 刑事法律的活动和执行在减少毒品使用方面基本上是无效的， PWUD的公共卫生结果。然而，在检察机关执行国家人权机构法的影响， 公共卫生在很大程度上仍然没有得到研究-同样没有研究的是检察人员之间的关系 以及当地的公共卫生和治疗基础设施。有了这个5年的K 01，P.I.旨在研究 检察官的作用，在解决过量的危机，重点是如何政策执行决策 受社会生态学（S.E.）因素，包括其他组织的存在（公共卫生 刑事法律的、公共的和社会的组织关系 以及此类起诉对药物使用和治疗的预期影响- 寻求行为。私家侦探将对检察官进行探索性半结构化访谈（AIM 1）， 公共卫生管理人员、地方管理实体成员、辩护律师和PWUD（AIM 2）， 北卡罗来纳州夺取了东南部检察官选择追究国家人权机构责任的地方存在的因素 案件与检察官选择不追究此类指控的地方存在的因素。 使用AIM 1和2中收集的数据，P.I.将开发一个社会生态模型（SEM）的政策 解释了S.E.因素（包括公共卫生和治疗基础设施）影响 DIH法律的执行情况，以及这种执行如何被认为会影响行为， PWUD的经验（AIM 3）。私家侦探将与一个有成就的，多学科的导师团队（博士。 Taxman、Rudes博士和Beletsky教授）掌握四个相关培训领域：（1）政策执行 科学，（2）先进的法律的流行病学评估，（3）定性访谈，（4）实施 研究设计.在这样做的过程中，这个K 01奖项推进了P.I.作为一个独立和 多产的研究者K 01奖中提出的研究解决了一个重要的公共卫生问题。 关注并有可能通过开发一个SEM来推进该领域，该SEM假定犯罪法律的行为者如何 与公共卫生基础设施相互作用，以影响有过量风险的人的公共健康。

PROJECT SUMMARY Through the research and training described in this K01 proposal, the P.I. (Dr. El-Sabawi) will acquire the necessary skills to become an independent researcher who uses legal epidemiological methods to study and design evidence-based laws and policies that improve the health of persons who use drugs (PWUD). Overdose deaths are surging across the U.S., with 40 states reporting increases in mortalities for the 12 month period ending in May 2022. Some prosecutors have responded to local overdose crises by charging persons who distribute drugs that cause an overdose death with homicide (drug-induced homicide) (DIH), resulting in dramatic increases in DIH prosecutions since 2011. Prior research has demonstrated that increased police activity and enforcement of criminal laws are largely ineffective in decreasing drug use and often lead to poorer public health outcomes for PWUD. However, the effects of the prosecutorial implementation of DIH laws on public health remains largely unstudied —equally as unstudied is the relationship between prosecutorial actors and the local public health and treatment infrastructure. With this 5-year K01, the P.I. aims to examine the prosecutor’s role in addressing the overdose crisis by focusing on how policy implementation decision-making is affected by socio-ecological (S.E.) factors, including the presence of other organizations (public health departments and treatment infrastructure); organizational relationships between the criminal legal, public health, and treatment systems; and the perceived effect of such prosecutions on drug use and treatment- seeking behaviors. The P.I. will conduct exploratory semi-structured interviews of prosecutors (AIM 1), local public health administrators, members of local management entities, defense attorneys, and PWUD (AIM 2) in North Carolina to capture the S.E. factors present in localities where prosecutors have chosen to pursue DIH cases versus the factors present in localities where prosecutors have chosen not to pursue such charges. Using the data gathered in AIMs 1 & 2, the P.I. will develop a Socio-Ecological Model (SEM) of policy implementation explaining how S.E. factors (including public health and treatment infrastructure) influence the implementation of DIH laws and how such implementation is perceived to influence the behaviors and experiences of PWUD (AIM 3). The P.I. will work with an accomplished, multidisciplinary mentorship team (Dr. Taxman, Dr. Rudes, and Prof. Beletsky) to master four relevant areas of training: (1) policy implementation science, (2) advanced legal epidemiological evaluation, (3) qualitative interviewing, and (4) implementation study design. In doing so, this K01 award advances the development of the P.I. as an independent and productive researcher. The research presented in this K01 award addresses an important public health concern and has the potential to advance the field by developing a SEM that posits how criminal legal actors interact with the public health infrastructure in ways that impact the public health of people at risk of overdoses.