LeMasters Katherine, Nall Samantha K, Jurecka Cole, Craft Betsy, Christine Paul J, Goodman Ryan, Henderson Jessie, Haywood-James Robert, Williams Angela, Wittner Grace, Barocas Joshua A
Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, 80045 CO, USA.
Department of Epidemiology, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
BMC Glob Public Health. 2025 Jan 2;3(1):1. doi: 10.1186/s44263-024-00117-7.
In the USA, many states, including Colorado, have increased criminal penalties for illicit opioid possession, which may alter overdose risk. We aimed to evaluate the relationship between Colorado's increased drug-related criminal legal penalties, risk of overdose, and substance use patterns.
We used concept mapping - a mixed-methods approach used to develop a conceptual understanding of an issue from a community lens - to engage with people with living and/or lived experience with the criminal legal system, substance use, and/or overdose, their loved ones, and service providers. In facilitated discussion, we used the prompt: "Do you see overdose and substance use, in Colorado, being impacted by an individual's involvement with the criminal legal system?" Participants - recruited from community-based organizations - identified, rated, sorted, and categorized factors affecting criminal legal involvement, substance use, and/or overdose in their community. We used groupwisdom to develop concept maps and to analyze findings.
Twenty-four individuals (ages 18-70) participated; most had living and/or lived experience. Participants identified 100 distinct factors, which were sorted into 9 clusters: societal impacts of criminal legal involvement, lifesaving benefits to decreased criminal legal penalties, environmental barriers of criminal legal involvement, structural barriers to recovery services, essential culturally aware community-based services, strategic allocation of funding, strategies to improve law enforcement's impact, changing policies to keep law enforcement accountable and better educate law enforcement on community culture, and community issues with law enforcement to prioritize. Of the 40 most influential and common factors, most related to structural impacts of criminal legal involvement and barriers to recovery (e.g., long waitlists, job loss).
Using concept mapping, we worked with community members to identify and prioritize factors associated with substance use and overdose amidst increasing drug-related criminal legal penalties. These insights (e.g., law enforcement's role should be acting as a bridge to mental health and recovery services) are critical for policymakers and service providers, as they speak to the need for investing in re-entry services, harm reduction services, and co-responder models for behavioral health crises.
在美国，包括科罗拉多州在内的许多州都加大了对非法持有阿片类药物的刑事处罚力度，这可能会改变过量用药风险。我们旨在评估科罗拉多州与毒品相关的刑事法律处罚增加、过量用药风险和物质使用模式之间的关系。
我们采用概念映射法——一种混合方法，用于从社区视角对一个问题形成概念性理解——与有刑事法律系统、物质使用和/或过量用药生活经历和/或亲身经历的人、他们的亲人以及服务提供者进行交流。在促进性讨论中，我们使用提示语：“在科罗拉多州，你认为个人与刑事法律系统的接触会对过量用药和物质使用产生影响吗？”从社区组织招募的参与者识别、评级、分类和归类了影响其社区刑事法律接触、物质使用和/或过量用药的因素。我们运用群体智慧来绘制概念图并分析研究结果。
24名年龄在18至70岁之间的个人参与了研究；大多数人有生活经历和/或亲身经历。参与者识别出100个不同的因素，这些因素被分为9个类别：刑事法律接触的社会影响、刑事处罚减轻带来的救命益处、刑事法律接触的环境障碍、康复服务的结构障碍、基于社区的必要文化意识服务、资金的战略分配、改善执法影响的策略、改变政策以确保执法部门负责并更好地让执法部门了解社区文化，以及需要优先处理的与执法部门相关的社区问题。在40个最具影响力和最常见的因素中，大多数与刑事法律接触的结构影响和康复障碍有关（例如，漫长的等候名单、失业）。
通过概念映射法，我们与社区成员合作，在与毒品相关的刑事法律处罚不断增加的情况下，识别与物质使用和过量用药相关的因素并确定其优先级。这些见解（例如，执法部门的作用应该是充当通往心理健康和康复服务的桥梁）对政策制定者和服务提供者至关重要，因为它们表明需要投资于重新融入社会服务、减少伤害服务以及针对行为健康危机的联合应对模式。
