The consequences of Medicaid expansion under the Affordable Care Act for police arrests

Background & methods National protests in the summer of 2020 drew attention to the significant presence of police in marginalized communities. Recent social movements have called for substantial police reforms, including “defunding the police,” a phrase originating from a larger, historical abolition movement advocating that public investments be redirected away from the criminal justice system and into social services and health care. Although research has demonstrated the expansive role of police to respond a broad range of social problems and health emergencies, existing research has yet to fully explore the capacity for health insurance policy to influence rates of arrest in the population. To fill this gap, we examine the potential effect of Medicaid expansion under the Affordable Care Act (ACA) on arrests in 3,035 U.S. counties. We compare county-level arrests using FBI Uniform Crime Reporting (UCR) Program Data before and after Medicaid expansion in 2014–2016, relative to counties in non-expansion states. We use difference-in-differences (DID) models to estimate the change in arrests following Medicaid expansion for overall arrests, and violent, drug, and low-level arrests. Results Police arrests significantly declined following the expansion of Medicaid under the ACA. Medicaid expansion produced a 20–32% negative difference in overall arrests rates in the first three years. We observe the largest negative differences for drug arrests: we find a 25–41% negative difference in drug arrests in the three years following Medicaid expansion, compared to non-expansion counties. We observe a 19–29% negative difference in arrests for violence in the three years after Medicaid expansion, and a decrease in low-level arrests between 24–28% in expansion counties compared to non-expansion counties. Our main results for drug arrests are robust to multiple sensitivity analyses, including a state-level model. Conclusions Evidence in this paper suggests that expanded Medicaid insurance reduced police arrests, particularly drug-related arrests. Combined with research showing the harmful health consequences of chronic policing in disadvantaged communities, greater insurance coverage creates new avenues for individuals to seek care, receive treatment, and avoid criminalization. As police reform is high on the agenda at the local, state, and federal level, our paper supports the perspective that broad health policy reforms can meaningfully reduce contact with the criminal justice system under historic conditions of mass criminalization.

Racially Charged Police Enforcement Has Cost the U.S. Economy $53 Billion to $220 Billion in Lost Productivity

There is a major difference in the drug arrest rate and incarceration rates between Black and White individuals. However, the drug use rate across the two groups is similar (and has been over time). This study estimates the lost productivity over time of people arrested on drug charges because they are Black. Ceteris Paribus, if those using the drugs were White, instead of Black, at the point of arrest and incarceration, what would have been their additional productivity levels over their lives? In this study I estimate this lost productivity to be $53 billion to $220 billion from 1980–2018 (in 2019-dollars), suggesting that the Lucas wedge is substantial for racial drug arrests.

Multiple drug arrests reported to the Maine Diversion Alert Program more frequently involved carisoprodol, amitriptyline, or quetiapine

Background: Much of the blame of the increasing death toll by drug overdoses has justifiably been attributed to the United States current opioid epidemic. However, nearly 80% of overdoses related to opioids involve another drug substance or alcohol. The objective of this study was to elucidate overrepresentation of drugs in polypharmacy arrests by identifying drugs that were more likely to be found in conjunction with other substances, using the drug arrest data provided by the Maine Diversion Alert Program (DAP). Methods: Single drug arrest and multiple drug arrest totals reported to the DAP were examined. Drugs involved in the arrests were classified by Drug Enforcement Administration Schedule (I-V or non-controlled prescription) and categorized into five drug families: hallucinogens, opioids, sedatives, stimulants, and miscellaneous. Multiple drug arrest totals were compared to single drug arrest totals to create a Multiple-to-Single Ratio (MSR) specific to each drug family and each drug. Chi-square approximations without Yates correction and two-tailed P values were used to determine statistical significance through GraphPad 2x2 contingency tables. Results: Over three-fifths (63.8%) of all arrests involved a single drug. Opioids accounted for over-half (53.5%) of single arrests, followed by stimulants (27.7%) and hallucinogens (7.7%). Similarly, nearly two-fifths (39.6%) of multiple arrests were opioids, followed by stimulants (30.8%) and miscellaneous (13.0%). Miscellaneous family drugs were recorded with the highest Multiple-to-Single Ratio (1.51), followed by sedatives (1.09), stimulants (0.63), opioids (0.42), and hallucinogens (0.35). Carisoprodol (8.80), amitriptyline (6.34), and quetiapine (4.69) had the highest MSR values and therefore were the three most overrepresented drugs in polysubstance arrests. Conclusion: The abuse of opioids, both alone and in conjunction with another drug, deserves continued surveillance in public health. In addition, common prescription drugs with lesser-known misuse potential, especially carisoprodol, amitriptyline, and quetiapine, require more attention by medical providers for their ability to enhance the effects of other drugs or to compensate for undesired drug effects.

Do Medical Marijuana Laws Increase Hard-Drug Use?

Medical marijuana laws generate significant debate regarding drug policy. For instance, if marijuana is a complement to hard drugs, then these laws would increase the usage not only of marijuana but also of hard drugs. In this paper I study empirically the effects of medical marijuana laws by analyzing data on drug arrests and treatment admissions. I find that medical marijuana laws increase these proxies for marijuana consumption by around 10–15 percent. However, there is no evidence that cocaine and heroin usage increases. From the arrest data, the estimates indicate a 0–15 percent decrease in possession arrests for cocaine and heroin combined. From the treatment data, the estimates show a 20 percent decrease in admissions for heroin-related treatment, although there is no significant effect for cocaine-related treatment. These results suggest that marijuana may be a substitute for heroin, but it is not strongly correlated with cocaine. © 2015 by The University of Chicago. All rights reserved.

Do Medical Marijuana Laws Increase Hard-Drug Use?

Medical marijuana laws generate significant debate regarding drug policy. For instance, if marijuana is a complement to hard drugs, then these laws would increase the usage not only of marijuana but also of hard drugs. In this paper I study empirically the effects of medical marijuana laws by analyzing data on drug arrests and treatment admissions. I find that medical marijuana laws increase these proxies for marijuana consumption by around 10–15 percent. However, there is no evidence that cocaine and heroin usage increases. From the arrest data, the estimates indicate a 0–15 percent decrease in possession arrests for cocaine and heroin combined. From the treatment data, the estimates show a 20 percent decrease in admissions for heroin-related treatment, although there is no significant effect for cocaine-related treatment. These results suggest that marijuana may be a substitute for heroin, but it is not strongly correlated with cocaine. © 2015 by The University of Chicago. All rights reserved.

The Racially Disparate Effects of Drug Arrest on High School Dropout

Racial biases in law enforcement over the past three decades have been linked to the racialized policies of the war on drugs. The author examines the educational consequences of the war on drugs on the lives of youth by analyzing racial differences in the impact of a juvenile drug arrest on high school dropout. Using data from the National Longitudinal Study of Adolescent and Adult Health, the author finds that juvenile drug arrests are more consequential for Black and darker phenotype Latinx youth, who are less likely to be involved in delinquent and criminal behaviors than white youth with drug arrests. The author suggests that racial disparities in drug enforcement may be creating a racialized selection bias among drug arrestees, leading to racially disparate consequences for drug arrests, but not for other types of arrest. The results hold important implications for how drug arrests can produce and sustain racial disadvantages in educational attainment.

Homicide and Drug Trafficking in Impoverished Communities in Brazil

Many studies demonstrate that homicides are heavily concentrated in impoverished neighborhoods, but not all socially disadvantaged neighborhoods are hotbeds of violence. Conducted in Belo Horizonte, Brazil, this study hypothesizes that the association between high rates of homicide and impoverished areas is influenced by the emergence of a specific type of street drug-dealing common to favelas (slums). The study applies econometric techniques to police data on homicides and drug arrests from 2008 to 2011, as well as 2010 Census data, to test its hypothesis. The findings provide insight into the development of crime prevention policies in areas of high social vulnerability.

County and Demographic Differences in Drug Arrests and Controlled Substance Use in Maine

Introduction: The Diversion Alert Program (DAP) was established to curb the misuse of drugs and help identify people in need of substance use disorder (SUD) treatment. Law enforcement compiled arrest data into a database accessible by health care providers. The objectives of this investigation were to identify regional and demographic differences in drug use and misuse in Maine. Methods: All arrests (N=11,234) reported to the DAP from 2013 to 2018 were examined by county, arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution of controlled pharmaceuticals (schedule I-V). Opioids were converted to oral morphine mg equivalents (MME). County and zip-code heat maps were constructed. Results: The counties with the most arrests per capita were Cumberland, Androscoggin, and Penobscot. Opioids were the most common drug class in arrests in all counties except Aroostook, where stimulants were most common. Medical distribution of opioids varied. With the exception of buprenorphine, which doubled, many prescription opioids like hydrocodone, fentanyl, and oxymorphone exhibited large (>50%) reductions. Methadone was the predominant opioid statewide (56.4% of the total MME) although there were sizeable differences (Presque Isle=8.6%, Bangor=78.9%) and this is likely impacted by use for SUD treatment. Amphetamine distribution increased by 67.9%. Conclusions: The DAP was useful to prevent information silos and enhance communication between law enforcement and health care providers. Maines DAP was a unique system to identify patients in need of additional treatment resources. The increase in prescription stimulants may warrant continued monitoring.