How Social Adversity and Opioid Prescription Intersect With the Criminal Justice System and Recent Mortality in the United States

Abstract

This dissertation advances a contextual understanding of the consequences of opioid prescription that extends beyond the realms of medicine and health. The first empirical chapter sets the scene by considering how contemporary drug poisoning mortality rates, which are largely driven by opioids, relate to well established socioeconomic and racial disparities in health. By situating drug poisoning mortality in the context of broader health disparities, I show that county-level drug mortality rates follow familiar social patterns with respect to socioeconomic status but unique social patterns with respect to race. The second chapter conceptualizes local opioid prescription rates as a social structural characteristic of counties, given the nonmedical use and illegal exchange of prescription opioids that has accompanied their increased prescription. Moving beyond health outcomes, I argue that prescription opioids constitute an institutional link between medicine and the criminal justice system. I assemble a county-level dataset that spans years 2000 through 2014 to test whether larger supplies of prescription opioids are associated with higher rates of prescription opioid drug arrests. I find that they are and that this relationship is not modified by counties’ social or criminal justice infrastructures. The third chapter, co-authored with a graduate student colleague, examines whether and how court officials attempt to address aspects of defendants’ social adversity, including drug addiction, following arrest. Drawing on over 100 interviews with state-level judges, prosecutors, and public defenders, we find that court officials exert social control at bail hearings in attempts to address aspects of defendants’ social adversity that court officials perceive as underlying defendants’ criminal court involvement. However, a smaller group of public defenders and judges believes that it is not appropriate to do so. We discuss the implications of these findings for socioeconomic and racial/ethnic disparities. Taken together, this dissertation’s empirical chapters reveal the importance of considering how social problems travel between institutions.