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

项目总结 通过K01提案中描述的研究和培训，P.I.(El-Sabawi博士)将获得 成为一名使用法律流行病学方法进行研究的独立研究员所需的技能 并设计以证据为基础的法律和政策，以改善吸毒者的健康(PWUD)。 美国各地服药过量死亡人数激增，40个州报告称，过去12个月死亡人数增加 截止日期为2022年5月。一些检察官对当地的吸毒过量危机做出了回应，对 世卫组织分发导致过量死亡的药物的杀人罪(药物诱导杀人罪)，导致 自2011年以来，DIH的起诉大幅增加。先前的研究表明，增加警力 刑法的活动和执行在减少毒品使用方面很大程度上是无效的，往往会导致更贫穷 PWUD的公共卫生后果。然而，检察机关实施DIH法律对 公共卫生在很大程度上仍未被研究--同样未被研究的是检察行为者之间的关系 以及当地的公共卫生和治疗基础设施。通过这份为期5年的K01，P.I.的目标是审查 检察官在通过关注政策执行决策如何解决吸毒过量危机中的作用 受到社会生态(S.E.)的影响因素，包括其他组织的存在(公共卫生 部门和治疗基础设施)；刑事、法律和公共部门之间的组织关系 健康和治疗系统；以及这种起诉对药物使用和治疗的已知影响-- 寻找行为。私家侦探将对检察官进行探索性半结构化面谈(AIM 1)，当地 公共卫生管理员、地方管理实体成员、辩护律师和PWUD(AIM 2) 北卡罗来纳州将捕捉检察官选择追查DIH的地区存在的S.E.因素 案件与检察官选择不追查此类指控的地方存在的因素。 利用在AIMS 1和2中收集的数据，P.I.将开发一个政策的社会生态模型(SEM 执行情况说明安全和安全因素(包括公共卫生和治疗基础设施)如何影响 DIH法律的实施以及这种实施如何被认为影响行为和 PWUD的经验(目标3)。私家侦探将与一支经验丰富的多学科指导团队(Dr。 税务人员、鲁德斯博士和别列茨基教授)掌握四个相关的培训领域：(1)政策执行 科学；(2)高级法律流行病学评估；(3)定性访谈；(4)执行 研究设计。通过这样做，这个K01奖项促进了P.I.作为一个独立和 多产的研究人员。在这个K01奖项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结构方程来推动该领域的发展，该结构假定刑事法律行为者如何 与公共卫生基础设施相互作用，以影响有过量用药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.