{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:30:04Z","timestamp":1792182604236,"version":"4.4.0"},"reference-count":51,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Opioid-involved overdose mortality has been on the rise for 2 decades in the US, exacerbated by an unregulated drug supply that is unpredictable and has increasingly contained highly potent fentanyl analogs starting a decade ago.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine whether there is a geospatial association between law enforcement drug seizures and opioid-involved overdose mortality in San Francisco.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study used location- and time-stamped overdose mortality data from the Office of the Chief Medical Examiner and publicly available crime data from the San Francisco Police Department between 2020 and 2023 to assess whether location and time of law enforcement drug seizures were associated with subsequent opioid-involved overdose mortality. Data were analyzed from January 2020 to September 2023.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Time-stamped locations of law enforcement drug seizures involving a drug distribution charge.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcomes were the time and location of (1) overdose mortality involving any opioid and (2) overdose mortality involving fentanyl or any fentanyl analog. The relative risk (RR) and 95% CIs for endemic and epidemic factors were calculated.<\/jats:p><\/jats:sec>Results<\/jats:title>There were 2653 drug seizure crime events that involved any drug distribution charge and 1833 overdose deaths that tested positive for any opioid or synthetic opioid, including heroin and fentanyl analogs. Within the surrounding 100 meters, law enforcement drug seizures were associated with increase risk of fatal opioid-involved overdoses the day following the drug seizure event (RR, 1.74; 95% CI, 1.06-2.83; P<\/jats:italic>\u2009=\u2009.03) and elevated risk persisted for 7 days (2 days: RR, 1.55; 95% CI, 1.09-2.21; P<\/jats:italic>\u2009=\u2009.02; 3 days: RR, 1.45; 95% CI, 1.08-1.93; P<\/jats:italic>\u2009=\u2009.01; 7 days: RR, 1.27; 95% CI, 1.11-1.46; P<\/jats:italic>\u2009=\u2009.001). Similar statistically significant spatiotemporal patterns were observed in the 250- and 500-meter spatial bandwidths. Within each space-time kernel, the strength of the association, all of which were statistically significant, dissipated the further away in time and distance from the law enforcement drug seizure event.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this cross-sectional study suggest that the enforcement of drug distribution laws to increase public safety for residents in San Francisco may be having an unintended negative consequence of increasing opioid overdose mortality. To reduce overdose mortality, it may be better to focus on evidence-based health policies and interventions.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.1158","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T15:22:38Z","timestamp":1742397758000},"page":"e251158","source":"Crossref","is-referenced-by-count":23,"title":["Law Enforcement Drug Seizures and Opioid-Involved Overdose Mortality"],"prefix":"10.1001","volume":"8","author":[{"given":"Alex H.","family":"Kral","sequence":"first","affiliation":[{"name":"RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie L.","family":"Humphrey","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde","family":"Schwab","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barrot H.","family":"Lambdin","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, North Carolina"},{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco"},{"name":"Department of Global Health, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Ray","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"issue":"5","key":"zoi250084r2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0303403","article-title":"Innovation and adaptation: the rise of a fentanyl smoking culture in San Francisco.","volume":"19","author":"Ciccarone","year":"2024","journal-title":"Plows One"},{"key":"zoi250084r3","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.13536","article-title":"Regional differences in fatal drug overdose deaths among Black and White individuals in the United States, 2012-2021.","author":"Jones","journal-title":"Am J Addict"},{"issue":"1","key":"zoi250084r5","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s13722-019-0145-5","article-title":"A conceptual model for understanding post-release opioid-related overdose risk.","volume":"14","author":"Joudrey","year":"2019","journal-title":"Addict Sci Clin Pract"},{"issue":"3","key":"zoi250084r6","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1177\/0963689718811060","article-title":"Historical review: opiate addiction and opioid receptors.","volume":"28","author":"Wang","year":"2019","journal-title":"Cell Transplant"},{"issue":"5","key":"zoi250084r7","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1111\/jcpt.13114","article-title":"Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: current understanding and approaches to management.","volume":"45","author":"Pergolizzi","year":"2020","journal-title":"J Clin Pharm Ther"},{"issue":"6","key":"zoi250084r8","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1080\/10826084.2024.2306221","article-title":"Characterizing opioid withdrawal experiences and consequences among a community sample of people who use opioids.","volume":"59","author":"Simpson","year":"2024","journal-title":"Subst Use Misuse"},{"issue":"3","key":"zoi250084r9","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.drugpo.2009.08.007","article-title":"Strategies to avoid opiate withdrawal: implications for HCV and HIV risks.","volume":"21","author":"Mateu-Gelabert","year":"2010","journal-title":"Int J Drug Policy"},{"issue":"4","key":"zoi250084r10","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1111\/1556-4029.14712","article-title":"Fentanyl-related substance scheduling as an effective drug control strategy.","volume":"66","author":"Weedn","year":"2021","journal-title":"J Forensic Sci"},{"key":"zoi250084r11","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.102695","article-title":"The protective effect of trusted dealers against opioid overdose in the US.","volume":"78","author":"Carroll","year":"2020","journal-title":"Int J Drug Policy"},{"issue":"7","key":"zoi250084r12","doi-asserted-by":"publisher","first-page":"750","DOI":"10.2105\/AJPH.2023.307291","article-title":"Spatiotemporal analysis exploring the effect of law enforcement drug market disruptions on overdose, Indianapolis, Indiana, 2020-2021.","volume":"113","author":"Ray","year":"2023","journal-title":"Am J Public Health"},{"key":"zoi250084r13","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1136\/jech-2024-222263","article-title":"Overdose as a complex contagion: modelling the community spread of overdose events following law enforcement efforts to disrupt the drug market.","volume":"79","author":"Humphrey","year":"2025","journal-title":"J Epidemiol Community Health"},{"key":"zoi250084r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.109003","article-title":"Transition from injecting opioids to smoking fentanyl in San Francisco, California.","volume":"227","author":"Kral","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"zoi250084r20","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1080\/08897077.2021.2010251","article-title":"\u201cI wanted something that was more flexible\u201d: a qualitative study of patient preferences on choosing buprenorphine over methadone in a large, safety-net hospital opioid treatment program.","volume":"43","author":"Checkley","year":"2022","journal-title":"Subst Abus"},{"key":"zoi250084r22","article-title":"Complex contagions: a decade in review.","author":"Guilbeault","journal-title":"Complex Spreading Phenom Soc Syst"},{"issue":"1","key":"zoi250084r23","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1038\/s41467-022-28958-6","article-title":"Transition from simple to complex contagion in collective decision-making.","volume":"13","author":"Horsevad","year":"2022","journal-title":"Nat Commun"},{"issue":"6","key":"zoi250084r25","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1007\/s11524-006-9094-x","article-title":"The development of a standardized neighborhood deprivation index.","volume":"83","author":"Messer","year":"2006","journal-title":"J Urban Health"},{"issue":"2","key":"zoi250084r26","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1111\/j.1541-0420.2011.01684.x","article-title":"A space-time conditional intensity model for invasive meningococcal disease occurrence.","volume":"68","author":"Meyer","year":"2012","journal-title":"Biometrics"},{"issue":"8","key":"zoi250084r28","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1056\/NEJMoa0810635","article-title":"Diacetylmorphine versus methadone for the treatment of opioid addiction.","volume":"361","author":"Oviedo-Joekes","year":"2009","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi250084r30","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1177\/0022427811419368","article-title":"The effects of focused deterrence strategies on crime: a systematic review and meta-analysis of the empirical evidence.","volume":"49","author":"Braga","year":"2012","journal-title":"J Res Crime Delinq"},{"issue":"2","key":"zoi250084r31","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1080\/00952990.2023.2169615","article-title":"A national survey of law enforcement post-overdose response efforts.","volume":"49","author":"Ray","year":"2023","journal-title":"Am J Drug Alcohol Abuse"},{"issue":"3","key":"zoi250084r32","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1177\/29767342241255480","article-title":"Methadone\u2019s resurgence in bridging the treatment gap in the overdose crisis: position statement of AMERSA, Inc (Association for Multidisciplinary Education, Research, Substance Use, and Addiction).","volume":"45","author":"Suen","year":"2024","journal-title":"Subst Use Addctn J"},{"key":"zoi250084r33","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103709","article-title":"Factors associated with 60-day adherence to \u201csafer supply\u201d opioids prescribed under British Columbia\u2019s interim clinical guidance for health care providers to support people who use drugs during COVID-19 and the ongoing overdose emergency.","volume":"105","author":"Selfridge","year":"2022","journal-title":"Int J Drug Policy"},{"issue":"19","key":"zoi250084r34","doi-asserted-by":"publisher","first-page":"E674","DOI":"10.1503\/cmaj.211515","article-title":"A low-barrier, flexible safe supply program to prevent deaths from overdose.","volume":"194","author":"Klaire","year":"2022","journal-title":"CMAJ"},{"issue":"6","key":"zoi250084r35","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1136\/jme-2021-108087","article-title":"Prescribing safe supply: ethical considerations for clinicians.","volume":"49","author":"Duthie","year":"2023","journal-title":"J Med Ethics"},{"key":"zoi250084r36","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2023.104155","article-title":"Changes in arrests following decriminalization of low-level drug possession in Oregon and Washington.","volume":"119","author":"Davis","year":"2023","journal-title":"Int J Drug Policy"},{"issue":"10026","key":"zoi250084r37","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1016\/S0140-6736(16)00619-X","article-title":"Public health and international drug policy.","volume":"387","author":"Csete","year":"2016","journal-title":"Lancet"},{"issue":"6","key":"zoi250084r39","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1056\/NEJMc2015435","article-title":"Evaluation of an unsanctioned safe consumption site in the United States.","volume":"383","author":"Kral","year":"2020","journal-title":"N Engl J Med"},{"issue":"5","key":"zoi250084r40","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/s11904-017-0363-y","article-title":"Public health and public order outcomes associated with supervised drug consumption facilities: a systematic review.","volume":"14","author":"Kennedy","year":"2017","journal-title":"Curr HIV\/AIDS Rep"},{"key":"zoi250084r41","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2023.110969","article-title":"Impact of a high-volume overdose prevention site on social and drug disorder in surrounding areas in San Francisco.","volume":"252","author":"Davidson","year":"2023","journal-title":"Drug Alcohol Depend"},{"key":"zoi250084r42","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.drugalcdep.2014.10.012","article-title":"Supervised injection services: what has been demonstrated: a systematic literature review.","volume":"145","author":"Potier","year":"2014","journal-title":"Drug Alcohol Depend"},{"key":"zoi250084r43","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108521","article-title":"Impact of an unsanctioned safe consumption site on criminal activity, 2010-2019.","volume":"220","author":"Davidson","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"zoi250084r44","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103923","article-title":"Increased solitary drug use during COVID-19: an unintended consequence of social distancing.","volume":"111","author":"Schneider","year":"2023","journal-title":"Int J Drug Policy"},{"key":"zoi250084r45","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2020.108153","article-title":"COVID-19 and overdose prevention: challenges and opportunities for clinical practice in housing settings.","volume":"119","author":"MacKinnon","year":"2020","journal-title":"J Subst Abuse Treat"},{"key":"zoi250084r46","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109440","article-title":"Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness.","volume":"235","author":"Brothers","year":"2022","journal-title":"Drug Alcohol Depend"},{"issue":"6","key":"zoi250084r47","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1007\/s11524-020-00436-8","article-title":"Geospatial variations and neighborhood deprivation in drug-related admissions and overdoses.","volume":"97","author":"Cobert","year":"2020","journal-title":"J Urban Health"},{"issue":"6","key":"zoi250084r48","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1093\/inthealth\/ihad015","article-title":"Individual-level and neighborhood-level shifts in mortality patterns among drug poisoning deaths in a high-density Asian city: a territory-wide, case-only analysis.","volume":"15","author":"Ho","year":"2023","journal-title":"Int Health"},{"issue":"5","key":"zoi250084r49","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.1016\/j.aap.2011.04.013","article-title":"Socio-economic inequalities in mortality due to injuries in small areas of ten cities in Spain (MEDEA Project).","volume":"43","author":"Gotsens","year":"2011","journal-title":"Accid Anal Prev"},{"issue":"1","key":"zoi250084r50","doi-asserted-by":"publisher","first-page":"98","DOI":"10.2105\/AJPH.2019.305368","article-title":"The geographic distribution of fentanyl-involved overdose deaths in Cook County, Illinois.","volume":"110","author":"Nesoff","year":"2020","journal-title":"Am J Public Health"},{"key":"zoi250084r29","doi-asserted-by":"crossref","DOI":"10.4324\/9781003154136","volume-title":"Drug Law Enforcement, Policing and Harm Reduction","author":"Bacon","year":"2022"},{"key":"zoi250084r1","unstructured":"US overdose deaths decrease in 2023, first time since 2018. US Centers for Disease Control and Prevention. Accessed June 5, 2024. https:\/\/www.cdc.gov\/nchs\/pressroom\/nchs_press_releases\/2024\/20240515.htm"},{"key":"zoi250084r4","doi-asserted-by":"crossref","unstructured":"Zoorob? M, Park? JN, Kral? AH, Lambdin? BH, del Pozo? B. Drug decriminalization, the introduction of fentanyl to drug markets, and fatal overdose in Oregon.? MedRXiv. Preprint published online April 22, 2024. doi:10.1101\/2024.04.08.24305508","DOI":"10.1101\/2024.04.08.24305508"},{"key":"zoi250084r15","unstructured":"Mayor London breed declares state of emergency in the tenderloin. Office of the Mayor. Accessed June 4, 2024. https:\/\/sfmayor.org\/article\/mayor-london-breed-declares-state-emergency-tenderloin"},{"key":"zoi250084r16","unstructured":"Felony narcotics prosecutions. San Francisco District Attorney. Accessed June 4, 2024. https:\/\/sfdistrictattorney.org\/news\/felony-narcotics-prosecutions\/"},{"key":"zoi250084r17","unstructured":"District Attorney Brooke Jenkins announces new misdemeanor drug policy to help drug users get treatment. San Francisco District Attorney. Accessed June 4, 2024. https:\/\/sfdistrictattorney.org\/press-release\/district-attorney-brooke-jenkins-announces-new-misdemeanor-drug-policy-to-help-drug-users-get-treatment\/"},{"key":"zoi250084r18","unstructured":"Governor Newsom launches new operation to improve public safety and target fentanyl trafficking. Governor of California. Accessed June 4, 2024. https:\/\/www.gov.ca.gov\/2023\/04\/28\/sf-fentanyl-operation\/"},{"key":"zoi250084r19","unstructured":"Treatment on Demand Act. San Francisco. Accessed August 1, 2024. https:\/\/www.sf.gov\/resource\/2022\/treatment-demand-act"},{"key":"zoi250084r21","unstructured":"San Francisco may be small, but it\u2019s among America\u2019s most densely populated cities. San Francisco Chronicle. Accessed June 15, 2024. https:\/\/www.sfchronicle.com\/sf\/article\/San-Francisco-may-be-small-but-it-s-among-16650575.php"},{"key":"zoi250084r24","unstructured":"2013-2017 American Community Survey (ACS) 5-year Estimates. US Census Bureau. Accessed May 31, 2019. https:\/\/www.census.gov\/programs-surveys\/acs\/technical-documentation\/table-and-geography-changes\/2017\/5-year.html"},{"key":"zoi250084r27","unstructured":"OpenStreetMap. Accessed February 14, 2025. https:\/\/www.openstreetmap.org\/#map=5\/38.01\/-95.84"},{"key":"zoi250084r38","unstructured":"Portugal, Country Drug Report 2019. Accessed June 4, 2024. https:\/\/www.emcdda.europa.eu\/publications\/country-drug-reports\/2019\/portugal_en"},{"key":"zoi250084r51","unstructured":"New report confirms US life expectancy has declined to lowest level since 1996. Accessed June 5, 2024. https:\/\/www.cdc.gov\/nchs\/pressroom\/nchs_press_releases\/2022\/20221222.htm"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2831697\/kral_2025_oi_250084_1741798600.74372.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T15:22:51Z","timestamp":1742397771000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2831697"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,19]]},"references-count":51,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.1158","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,19]]}}}