Jurecka Cole, Adams Joella, Padmanabhan Pranav, Glanz Jason, Christine Paul, Guan Xiaoyu, Kline Danielle, Binswanger Ingrid, Barocas Joshua
Division of General Internal Medicine, University of Colorado School of Medicine, Aurora.
RTI International, Durham, North Carolina.
JAMA Health Forum. 2025 Aug 1;6(8):e252654. doi: 10.1001/jamahealthforum.2025.2654.
In 2022, Colorado passed legislation making possession of small amounts of fentanyl, a high-potency synthetic opioid, a felony. Whether the Colorado law affected opioid overdose fatalities and whether those effects differed by racial and ethnic subgroups is unknown.
To estimate the association between the change in criminal penalties for fentanyl possession with opioid-related overdose deaths (OODs) in Colorado.
DESIGN, SETTING, AND POPULATION: Serial cross-sectional study comparing OODs among adults (≥18 years) who died of an overdose and population estimates before and after Colorado House Bill (HB) 22-1326 was enacted in July 2022 (January 2018-November 2023) using autoregressive integrated moving averages (ARIMA) model time series forecasting. Monthly OOD rates per 100 000 residents were calculated using state population estimates from the American Community Survey 5-Year Data and the Colorado Department of Local Affairs State Demography Office. Overdose death rates were calculated separately by racial and ethnic group (Hispanic, non-Hispanic Black, and non-Hispanic White). Data were analyzed from January 2018 to 2023.
Enactment of HB 22-1326 changed the legal penalty for possession of any drug weighing 1 g to 4 g that contained any amount of fentanyl from a misdemeanor to a level-4 drug felony punishable by up to 180 days in jail and up to 2 years of probation.
The difference between expected and observed OOD rates following the enactment of increased criminal penalties.
A total of 7099 OODs were analyzed (1798 Hispanic [25.3%], 451 Non-Hispanic Black [6.4%], and 4170 Non-Hispanic White [58.7%], 680 other [9.5%] and not included in the race and ethnicity categories). OODs increased across the study period in Colorado from 20.46 per 100 000 adults in January 2018 to 37.78 per 100 000 adults in November 2023. Among different racial and ethnic groups, the non-Hispanic Black population had the highest increase in OODs (9.3 per 100 000 in 2018 to 56.9 per 100 000 in 2023) followed by the Hispanic population. There was no difference between the observed and expect overdose deaths for the overall population following the enactment of HB 22-1326. However, there were significant increases in 4 of 13 months after policy implementation among the non-Hispanic Black population.
The results of this serial cross-sectional study suggest that increased criminal penalties for fentanyl possession did not change preexisting trends of OODs in Colorado and may have been associated with an increase in opioid overdoses in the Black population. These results should be interpreted in light of increasing opioid overdose rates in Black populations nationally during the study period.
2022年，科罗拉多州通过立法，将持有少量芬太尼（一种高效合成阿片类药物）定为重罪。科罗拉多州的这项法律是否影响了阿片类药物过量致死情况，以及这些影响在不同种族和族裔亚群体中是否存在差异尚不清楚。
评估科罗拉多州持有芬太尼刑事处罚变化与阿片类药物相关过量死亡（OODs）之间的关联。
设计、背景和人群：采用自回归积分滑动平均（ARIMA）模型时间序列预测进行的系列横断面研究，比较2022年7月科罗拉多州众议院法案（HB）22 - 1326颁布前后（2018年1月至2023年11月）死于过量用药的成年人（≥18岁）中的OODs情况以及人口估计数。每10万居民的月度OOD率使用美国社区调查5年数据和科罗拉多州地方事务部州人口统计办公室的州人口估计数计算得出。过量死亡率按种族和族裔群体（西班牙裔、非西班牙裔黑人、非西班牙裔白人）分别计算。数据于2018年1月至2023年进行分析。
HB 22 - 1326的颁布将持有任何含有任何数量芬太尼且重量为1克至4克的毒品的法律处罚从轻罪改为4级毒品重罪，最高可判处180天监禁和2年缓刑。
刑事处罚加重颁布后预期和观察到的OOD率之间的差异。
共分析了7099例OODs（1798例西班牙裔[25.3%]，451例非西班牙裔黑人[6.4%]，4170例非西班牙裔白人[58.7%]，680例其他[9.5%]，未纳入种族和族裔类别）。在研究期间，科罗拉多州的OODs从2018年1月每10万成年人中的20.46例增加到2023年11月的每10万成年人中的37.78例。在不同种族和族裔群体中，非西班牙裔黑人人口的OODs增加最多（从2018年每10万中的9.3例增加到2023年每10万中的56.9例），其次是西班牙裔人口。HB 22 - 1326颁布后，总体人群中观察到的和预期的过量死亡之间没有差异。然而，在政策实施后的13个月中有4个月，非西班牙裔黑人人口中的过量死亡显著增加。
这项系列横断面研究的结果表明，对持有芬太尼加重刑事处罚并未改变科罗拉多州OODs的原有趋势，且可能与黑人人口中阿片类药物过量增加有关。鉴于研究期间全国黑人人口中阿片类药物过量率不断上升应结合这一情况来解释这些结果。
