An important examination of the ecology of fatal drug overdoses in Pennsylvania’s largest city has revealed a devastating confluence of poverty, policing tactics, and crumbling housing stock. Conducted by Lallen T. Johnson, assistant professor, American University’s School of Public Affairs, and Tayler Shreve, Ph.D. student at AU’s School of Public Affairs, the study reveals a relationship between overdose mortality and the conditions of neighborhoods in a city in which nearly three out of every 10 residents know someone who has suffered a fatal overdose.
“We knew already that neighborhoods differ in their abilities to address many social problems and solicit resources from city agencies that may be helpful to residents and stakeholders,” said Johnson. “However, it is less clear how attributes of urban neighborhoods, such as housing conditions and local police responses, are related to fatal drug overdoses, particularly in Philadelphia, which is the sixth most populous city in the United States."
In 2016, Philadelphia had an overdose mortality rate of 59.4 per 100,000 residents, ranking it second in the nation among United States counties with at least 1 million residents. Researchers analyzed Philadelphia Medical Examiner’s Office data from 2011 to 2017 to model overdose mortality using community-level indicators of social control, disadvantage, and the built environment.
According to Johnson and his co-author, ZIP codes with more police arrests for minor offences have higher overdose mortality rates. This suggests that variations in police activity across neighborhoods may shape individual decisions to call for help when witnessing or experiencing an overdose. Fear of legal penalties has the potential to isolate persons who are experiencing overdose symptoms from critical medical care, thus increasing the likelihood of subsequent death.
The study also indicates that overdose deaths occur most frequently in areas with higher concentrations of vacant, aged, and dilapidated buildings that can provide a potential space in which illicit drugs can be consumed. Although such spaces may provide refuge from police contact, they also isolate people who use drugs from critical care in the event of an overdose, and thus increase the likelihood for fatalities to occur. Researchers believe that local policies and practices that strictly regulate the conditions of the built environment may help prevent properties from reaching points of disrepair in the first place.
The new research highlights the need to understand the social contexts in which drug mortality is most salient and underscores the need for comprehensive interventions to address multiple risk factors for negative health outcomes.
The study supports calls for interventions that reduce the harms associated with drug use, while also deemphasizing formal criminal justice system processing and punishment. Reliance on the criminal system to address drug use and addiction has the potential to yield significant public health consequences.
“We need to learn more about how social, environmental and legal conditions across places over time influence drug mortality,” said Johnson. “For example, while Good Samaritan laws provide witnesses immunity from prosecution under certain circumstances, future research should consider whether conflicting public health and justice system goals undermine their potential.”