Jascha Wagner’s research while affiliated with Texas A&M International University and other places

Objective: Previous studies show the reach of the current drug overdose epidemic into the U.S.-Mexico border region, albeit with a unique border-specific wave pattern compared to national waves and a delayed onset of fentanyl involvement (Wave I: 2002-2011, Wave II: 2012-2016, and Wave III: since 2017). The objective of this study is to examine the community predictors and the progression of overdose deaths across the U.S-Mexico border-specific epidemic waves. Method: Descriptive epidemiological profile of border communities across the unfolding of the opioid epidemic, integrated data from the CDC-WONDER multiple causes of death data set, the CDC SVI, Uniform Crime Report, and the Behavioral Risk Factor Surveillance System. Using spatially adjusted Bayes rates by border-specific epidemic waves, we provide a descriptive profile of the spatial unfolding of the drug overdose epidemic. Negative binomial regression models assessed community predictors of overdose deaths across waves. Results: Spatial analysis identified moderate to steep increases in drug overdose deaths over the three waves along the border. The impact and unfolding of the epidemic in the U.S.-Mexico border region were not uniform and affecting communities with differing severity and timing. Our study also finds support for social vulnerability and community violence as predictors of overdose deaths over the current wave of the epidemic. Conclusion: Findings suggest that more disadvantaged U.S.-Mexico border communities may encounter increasing rates of overdose death over the coming years. Interventions need to target not only the supply side but also the underlying social root causes for sustainable overdose prevention.

The journey to drug crime literature has found that, in cities, Black people travel shorter distances from their homes before being arrested relative to White people. Per race and rationality theory, the racialization of space shapes the decision-making processes of people arrested for drug offenses. Because residential segregation patterns and racialized social structures differ across levels of urbanization, this study uses negative binomial regression models to evaluate Black-White differences in journeys to crime for drug possessions, and the study assesses socioeconomic and opportunity characteristics of offense locations at the micro-level using drug arrest reports across the State of Delaware. We find that travel distances and predictors of offense locations differ across geographic areas (i.e., small cities, suburban areas, small towns, rural areas, and touristic rural areas). A place’s racial composition, concentrated disadvantage, and opportunity characteristics differently impact offense locations across geographic areas. Accordingly, in studying journeys to crime, researchers should consider the various ways that race shapes constructions of crime and place across the rural–urban continuum.

Objective: To examine whether overdose deaths and related metrics-overdose calls for service to police and non-fatal overdose emergency department visits-in Delaware follow within-year (i.e., seasonal) patterns during the most recent years of the opioid epidemic (2016-2020). Methods: We begin by providing descriptive statistics on yearly trends in overdose metrics, followed by Analysis of Variance (ANOVA) to analyze whether seasonal variations have a significant impact on the patterns of Delaware's overdose metrics while controlling for annual variations. Results: We find yearly variations across the three overdose-related metrics, with overdose deaths reporting the only consistent increases per year. Within-year, or seasonal, variations show the spring months have the most consistent increases in overdose deaths and overdose calls for service across years we studied. Finally, we report significant differences for all overdose metrics across years and seasons. Conclusions: As in prior studies, we find significant variation in overdose-related metrics by season in Delaware. Policy implications: These findings lend support to existing interventions in slowing yearly growth in overdose deaths. However, allocation of resources and interventions to specific times of the year-when overdoses are highest-may further reduce risks and harms.

Increases in opioid overdose deaths have been pronounced throughout the nation. The current narrative about them stresses their reach into middle-class America while theories that link substance use etiology and drug markets, such as availability-proneness theory, suggest that lower-income communities should be most impacted. The latter might be especially true due to the increased involvement of cheap and highly potent fentanyl. This study uses group-based multi-trajectory models and path analysis to assess relations among neighborhood opioid-overdose death trends, drug type compositions, and socioeconomic neighborhood characteristics across Delaware from 2013 to 2017. We find support for availability-proneness theory, insofar as drug availability and substance use are associated with neighborhoods in the trajectory groups with the highest overdose death rates. Moreover, we find that neighborhood disadvantage is associated with increased drug availability as well as substance use. Our results also suggest that open-air drug market access might be associated with an increased risk of fentanyl and heroin exposure which, in turn, can lead to spikes in overdoses net of other risk factors. Overall, our findings reveal the social character of the opioid epidemic and inform the literature on social inequality and drug use. We highlight the need for community reinvestment and harm reduction strategies to alleviate the drug problems in the most disadvantaged communities.

Journeys to crime, or distances traveled from residences to places of alleged crimes, describe how people enter into the criminal justice system. Race, as an ascribed characteristic of individuals and a determinant of community conditions, introduces disparities in journeys to crime. Use of opioids among nonurban, White populations and changing law enforcement responses prompt inquiry into how race affects journeys to crime associated with opioid possession. This study evaluates Black–White differences in travel among persons arrested for opioid possession in Delaware. It applies race and rationality theory to assess the effects of race and racialized context on travel patterns. Multilevel models reveal travel to possess opioids is greater for White relative to Black Delawareans. Community conditions such as marijuana possession arrest rates and concentrated disadvantage have varying impacts on travel from various geographic areas. Racial–spatial differences in travel show persistent disparities in drug law enforcement amid efforts to curb opioid misuse.

Background: The US opioid epidemic largely featured deaths from prescribed medications during Wave 1 (1990–2010), but its progression since then has resulted more so from deaths to illegal opioids—such as heroin (Wave 2 – 2010–2013) and fentanyl (Wave 3 – 2013-present). As deaths to illegally manufactured fentanyl have increased, attention to the role of prescribed opioids may be waning. However, the shifting nature of today’s opioid epidemic demands we monitor how both legal and illegal drugs are involved in overdose deaths. Objectives: The purpose of our study is to investigate the prescription drug (Rx) records of overdose death decedents to illuminate the continued role of prescribed medications in Wave 3 deaths. Methods: We matched drug overdose death data and prescription drug monitoring data to investigate the prescription drug records (i.e. types of opioids and other medications) of Delaware, USA, decedents who died from a drug overdose death between January 1, 2013, and March 31, 2015 (27 months). Results: Fentanyl decedents differed significantly from other decedents in prescribed medications, including the amount and proximity of opioid and Rx fentanyl prescriptions before death. These relationships held while controlling for demographic characteristics and contributing health conditions. Conclusions: Our findings show a continued presence of Rx opioids in overdose deaths and that those dying from fentanyl had different Rx records than those who died from other drugs. Continued monitoring of Rx drugs, improved toxicology testing and greater data access for more research should follow to inform effective interventions.

Opioid abuse has redefined drug problems in communities and shifted police activities to redress substance use. Changing neighborhood context around opioid issues may affect arrests and racial disparities in their imposition. This study presents a spatial analysis of arrests involving Blacks and Whites for possession of heroin, synthetic narcotics, and opium offenses. We identify the ecological conditions associated with opioid-related arrests using geographically weighted regression (GWR) methods that illuminate local patterns by allowing coefficients to vary across space. GWR models reveal spatial and racial differences in opioid-related possession arrest rates. Calls for police service for overdoses increase White arrests in more advantaged, rural communities. Economic disadvantage and racial diversity in neighborhoods more strongly elevate possession arrest rates among Blacks relative to Whites. Overdose calls predict Black arrests in poorer urban areas. Findings underscore police responsiveness to opioid problems and Black–White differences in how opioid users interact with the criminal justice system.

Objective: Drug overdoses among men have historically outnumbered those among women by a large margin. Yet, U.S. research on the first wave of the opioid epidemic involving prescription opioids has found women to be at increased risk. The current study considers if the narrowing gender gap in overdose deaths, as observed during the first wave, has continued into the most recent third wave, dominated by synthetic opioid deaths. This requires consideration of interactions between gender, age, and type of drug implicated. Method: Drawing on 2013-2017 Delaware toxicology reports for a total of 890 overdose deaths involving opioids, we distinguished between four gender/age groups--women 15-44, women 45-64, men 15-44, and men 45-64--to calculate crude death rates, male-to-female death rate ratios, and younger-to-older death rate ratios by type of opioid. Results: Opioid overdose death rates during the third wave increased among both men (+102%) and women (+46%), but the larger increase among men resulted in an increase in the male-to-female death rate ratio (from 1.9 to 2.6). This trend was driven by the growing contribution of fentanyl (from 16% to 76%) and heroin overdose deaths (from 27% to 50%) compared with other opioid overdose deaths, which disproportionately affected men and younger individuals. Higher male-to-female death rate ratios were observed among older, compared with younger, individuals. Conclusions: Overdose deaths seem to have returned to a historically familiar pattern of dominance by younger males. Our findings suggest the gender-age distribution in deaths to specific opioid types must be considered for effective intervention.

As opioid addiction has risen in recent years, racial disparities in drug arrests may be changing in their size and sources. Neighborhood conditions, like economic disadvantage and racial composition, are powerful determinants of racial differences in arrests. Overdoses and police responses to these incidents may, however, alter the neighborhood context of drug arrests, especially those tied to heroin, synthetic narcotics, and related opium derivatives offenses. This study revisits the environmental correlates of arrest disparities by conducting a neighborhood-level analysis of Black–White differences in drug possession and selling arrests by substance type across the State of Delaware. Spatial model estimates suggest economic disadvantage and racial diversity in neighborhoods substantially increase Black arrest rates. Conversely, White arrest rates grow with more calls for service for overdose incidents, racial homogeneity, and to a lesser extent, economic disadvantage within a community. Disparities in arrest also vary by substance type, as heroin arrests for Whites are most correlated with higher overdose service calls relative to White arrests for marijuana, cocaine, and other substances or Black arrests for any substance. Results underscore the need to reexamine neighborhood conditions and arrest disparities due to emerging shifts in drug use and drug law enforcement.

The current opioid epidemic continues to challenge us in new and potentially troubling ways. For example, research today finds more overdose deaths occurring in rural, rather than urban, geographic areas. Yet, studies have often ignored heterogeneities within these spaces and the neighborhood variations therein. Using geodemographic classification, we investigate neighborhood differences in overdose death rates by geographical areas to further understand where and among what groups the problem might be most concentrated. For deaths between 2013 and 2016, we find significant variation in rates among neighborhoods, defined by their socio-economic and demographic characteristics. For example, overdose death rates vary up to 13-fold among neighborhoods within geographic areas. Our results overall show that while the rural or urban classification of a geographic area is important in understanding the current overdose problem, a more segmented analysis by neighborhood’s socio-economic and demographic makeup is also necessary.