Modeling the effect of drug courts in North Carolina counties

Abstract Background Illicit opioid overdose death rates drastically increased across North Carolina through 2023. We sought to study the impact of drug courts and what conditions can make their presence more or less effective. Methods We analyzed counts of illicit opioid overdose deaths for each county in North Carolina from 2017–2023. Bayesian Poisson autoregressive models are used to model the change in temporal rate ratio of illicit opioid overdose deaths. We included an indicator of drug court presence in the model and used interaction terms to quantify effect heterogeneity. We used our model to estimate counterfactual outcomes and quantify the effect of drug courts. Results We found drug courts were associated with decreases in the growth rate of illicit opioid overdose death rates, and that the effect was heterogeneous across North Carolina. We estimated a large protective effect in counties that are urban and have a HIDTA designation, after controlling for other covariates. Conclusion Diversion into drug courts can provide an effective pathway to reducing the overdose crisis, but the effectiveness of drug courts depends on other features of the county.