By Anna Livia Arida

 On July 28, 2023, São Paulo military police launched one of the deadliest police operations in the state in 30 years in response to the killing of an officer. Police killed 28 people may also have committed acts of torture and other serious violations. Investigations into the killings were deeply flawed: for instance, police failed to request forensic analysis of many shooting sites and gunshot residue tests on some of the victims who allegedly shot at the police. Brazil has long had a serious problem with police abuse and excessive use of force. Police killed more than 6,400 people in 2022, 83 percent of them Black. São Paulo authorities should act urgently to prevent revenge operations by police. Throughout Brazil, independent prosecutors, rather than police themselves, should lead investigations into killings by police.  

New York:Human Rights Watch, 2023. 24p.

By Human Rights Watch

Many women imprisoned under Japan’s criminal justice system suffer serious violations of their human rights. The system overly depends on imprisonment and does not provide sufficient alternatives, such as community service. Mothers of young children are particularly affected. “They Don’t Treat Us Like Human Beings” documents the abusive conditions and policies of women’s prisons in Japan that contravene rules set out in the United Nations Standard Minimum Rules of the Treatment of Prisoners, known as the Nelson Mandela Rules. These include the use of restraints on imprisoned pregnant women, arbitrary use of solitary confinement, inadequate access to health and mental health care, criminalization of simple drug-related violations without effective treatment, and a lack of effective and independent oversight of prisons. Based on interviews with nearly 70 people, including several dozen formerly imprisoned women, the report demonstrates not only the poor human rights situation of women’s prisons in Japan, but also the few opportunities for alternatives to imprisonment. Japan’s government should urgently reform its justice system to ensure that the rights of all imprisoned people are fully respected in line with international human rights standards.  

New York:Human Rights Watch, 2023. 102p.

By Human Rights Watch

 Violence against women and girls with disabilities by those who are often closest to them, such as partners or family members, is a serious concern in Kyrgyzstan. Women and girls with disabilities experience domestic violence, including rape, beatings, neglect, and humiliation, in some cases on a daily basis. They are often left without the means to communicate or receive basic support, are socially isolated, and financially controlled. Abused by Relatives, Ignored by the State—based on interviews with survivors of domestic violence, social workers, and experts in three provinces of Kyrgyzstan—documents the violence and state response. It shows how such violence typically goes unreported and unaddressed due to widespread discrimination against people with disabilities in Kyrgyzstan, especially women and girls, whose families often perceive their existence as shameful and hide them from society. It also shows that state agencies are failing to ensure appropriate accommodations in schools and delivery of social services, and law enforcement and justice authorities are doing too little to combat the normalization of such discrimination and violence. Human Rights Watch calls on the Kyrgyz government to shift from a medical to a human rights model in its approach to disability, to provide reasonable accommodations in schools and social protection structures, and to ensure access to justice for survivors of violence.  

New York: Human Rights Watch, 2023. 83p.

By Martina Rapido Ragozzino and Juan Pappier

 In 2023, over half a million people crossed the Darién Gap, a swampy jungle between Colombia and Panama, most with the intention of heading to the United States. During their journey through this difficult terrain, many people from the Americas, including Venezuelans, Haitians, and Ecuadorians as well as people from Asia and Africa experienced serious abuses, including sexual violence. Dozens, if not hundreds, have lost their lives or gone missing trying to cross. Neglected in the Jungle: Inadequate Protection and Assistance for Migrants and Asylum Seekers Crossing the Darién Gap, the second in a series of Human Rights Watch reports on migration via the Darién Gap, focuses on Colombia’s and Panama’s responses to migration across their joint border. It identifies specific failures by both governments to effectively protect and assist these people—including those at higher risk, such as unaccompanied children—as well as to investigate abuses against them. Whatever the reason for their trip, migrants and asylum seekers crossing the Darién Gap are entitled to respect for their human rights during their journey. Colombia and Panama can and should do more to ensure their rights, including by taking appropriate steps to ensure access to food, water and basic health services and strengthening efforts to prevent and investigate abuses. 

New York:Human Rights Watch, 2024. 116p. 

By Shayna Bauchner

The Malaysian government is currently detaining about 12,000 refugees and migrants, including over 1,400 children, in dozens of immigration detention centers across Malaysia in conditions that put them at serious risk of physical abuse and psychological harm. Malaysian law makes all irregular entry and stay in the country a criminal offense, while placing no legal limit on the length of immigration detention, leaving migrants at risk of being detained indefinitely. “We Can’t See the Sun” documents Malaysia’s use of prolonged, judicially unsupervised immigration detention in violation of international human rights law. Based on interviews with former detainees as well as family members, humanitarian aid staff, and former immigration officials, the report details the authorities’ punitive and abusive treatment of undocumented migrants and asylum seekers. Immigration detainees may spend months or years in overcrowded, unhygienic conditions, subject to degrading treatment and abuse by guards, without domestic or international monitoring. Both ill-treatment and inadequate medical care have led to hundreds of deaths in immigration detention facilities in recent years. Human Rights Watch calls on the Malaysian government to reduce its reliance on immigration detention and move toward abolishing it entirely. Authorities should urgently stop detaining refugees, children, trafficking victims, and other vulnerable migrants for immigration related reasons. Malaysia should pursue community-based alternatives to detention that would not only counteract abusive and unnecessary immigration detention, but also make the immigration system more cost-effective, efficient, and humane.

New York: Human Rights Watch, 2024. 66p    

By Norma Herrera. et al

In March 2021, the US state of Texas established a far-reaching and abusive border militarization program called Operation Lone Star, which remains in effect. One part of this initiative incentivizes Texas state troopers and other law enforcement personnel to engage in dangerous and deadly high speed vehicle pursuits, seeking to apprehend drivers suspected of transporting unauthorized migrants, as well as the migrant passengers themselves. “So Much Blood on the Ground” finds that at least 74 people were killed and 189 injured due to vehicle pursuits in the 60 Texas counties that participated in Operation Lone Star between March 2021 and July 2023. During those 28 months, 7 bystanders were killed, including a seven-year-old girl. The pursuits can be reckless: One-third of the pursuits involved speeds over 100 miles per-hour. In interviews for this report, current and former Texas law enforcement personnel explained that there are ways to apprehend suspects without chasing them in vehicles. In this report and elsewhere, Human Rights Watch has extensively documented the impact of Operation Lone Star, finding the program has increased racial profiling of border residents and consistently violated other rights of migrants and asylum seekers as well as US citizens. Texas should dismantle Operation Lone Star and end deadly vehicle pursuits. Until that happens, the US federal government should cease funding agencies implementing Operation Lone Star and send civil rights officials to investigate violations of civil and human rights under the program, including the most fundamental human right of all: the right to life  

New York: Human Rights Watch,  2023. 78p.

 By Khalid Mahmood , John Jenkins and Martyn Frampton 

Policy Exchange this week shone a light on how the term ‘Islamophobia’ is being regularly misused to silence open debate about contemporary issues, with a series of egregious examples since the 7/10 attacks on Israel by Hamas catalogued in this new report.

The authors - including senior Labour MP Khalid Mahmood, Sir John Jenkins, former UK Ambassador to Saudi Arabia and author of the official 2014 UK Review of the Muslim Brotherhood and senior academic Martin Frampton - conclude that the use of the term ‘Islamophobia’ has become wider, less coherent and at times inflated to a remarkable degree. They argue that the threat to freedom of speech could not be more clearly signposted. In the absence of any single definition, the authorities should maintain their efforts to tackle anti-Muslim – as indeed any - prejudice, bigotry, and hatred in all its forms.

London: Policy Exchange, 2024. 22p.

By Eugenio Weigend Vargas, H. Hsieh, +1 author Jason E. Goldstick

Firearm homicides are increasing in the United States, and firearm homicides are a critical driver of racial health disparities. One such disparity that has received limited attention is excess firearm homicides among Hispanics, relative to White Non- Hispanics; comprehensively characterising this disparity is the purpose of this brief report. Using data from CDC WONDER, we examined temporal trends (2012–2021) in firearm homicide rate disparities between Hispanics and White Non- Hispanics in the U.S. Focusing on recently elevated rates (2018–2021), we estimated this disparity across demographics (gender, age, urbanicity, and race), and across U.S. states. These data clearly show nearly universal excess firearm homicide among Hispanics, relative to White Non- Hispanics, with larger differences among men, younger age groups, and in metropolitan areas. Similarly, nearly all states show higher rates of firearm homicide among Hispanics, relative to White Non- Hispanics, though the magnitude of the difference varies substantially 

Injury Prevention, August 2023. 

By Emily Mooney and Casey Witte

  Over 50 years ago, President Richard Nixon kindled a fire of fear by claiming drug addiction was a rampant problem among white, well-to-do teens. During a 1969 speech to governors across the nation, President Nixon remarked:

There has been sort of a general thought that so far as drugs were concerned, we find them in the ghettos, among the deprived, those who are depressed and turn to drugs as a last resort. That may have once been the case. It is not the case today. The primary use, as far as drugs are concerned, has moved to the upper middle class…

No longer seen as a problem simply relegated to the inner city, Republican and Democrat policymakers enacted policies which attempted to save youth from the perils of marijuana and narcotics by further criminalizing drug use and sales. Yet, while both urban Black leaders and suburban whites supported these changes, the former group did not benefit from investments in efforts to address the root causes of addiction—poverty, trauma and poor educational opportunities, among them—for which they advocated.

Much of the War on Drugs was based on misinformation and fear. Drug users and sellers in America’s urban centers were seen as sources of corruption—their incarceration necessary to prevent more addiction and crime. However, research suggests increased criminal penalties and other policy efforts to fight illicit drug use have had little effectiveness. Indeed, many American youth continue to use illicit drugs at high rates. And while some research suggests marijuana use may bring some harmful side effects, its role as a “gateway” drug to more addictive substances like heroin and cocaine was largely over-stated. For instance, at least one recent study suggests that the legalization of marijuana has not been marked with an increase in the use of harder substances.

Currently, opportunities for and examples of misinformation and fear-mongering within the criminal justice system are bountiful. The United States is facing a global health crisis and struggling to productively address long-standing issues of racial injustice. In the first half of 2020, our nation continued to see property crime and most forms of violent crime decrease, while murder and nonnegligent manslaughter rates (although historically still low) rose by nearly 15 percent when compared to the first half of 2019, while aggravated assaults rose by about 5 percent.8 Although still one of the most crime-free times in our nation’s history, many have been quick to blame this increase on policy changes, such early prison releases due to the COVID-19 pandemic, and civil unrest. Yet, as experts have pointed out, the intersecting forces of a global pandemic, economic recession, racial unrest and nationwide protests mean it will take more time, data and intentional analysis to decipher the causal mechanisms of any current crime trends.

In both the past and present, it has been easy for criminal justice policy to be driven by fear and emotional policymaking rather than a sober assessment of the facts. This occurs for somewhat natural reasons, as the consequences of criminal justice policy failures can appear more immediate and visceral: the potential for the death of a loved one, lost property or abuse are far more tangible concepts than cybersecurity threats or green energy. This is likely, at least in part, due to human memory—research shows experiences and events tied to strong emotions are more memorable than less dramatic or weighted incidents. Further, policy success is often measured by recidivism—a zero-sum measure of an individual’s return to crime—rather than other metrics which show incremental progress. On top of this, the media, more often than not, focuses on policy failures rather than policy successes.

Yet, fear-based and emotionally-driven policy debates and policymaking are a disservice to the American public. Policymakers and the public may incorrectly deduce or be blind to the collateral consequences of their policies and are prone to letting biases impact their decision-making. As a result, the same problems remain, which cost life, property and liberty in the process.

This paper seeks to address this trend by first examining the relationships between fear, misinformation and policy and then providing illustrative examples of modern criminal justice myths alongside the evidence stacked against them. It will then conclude with a short list of policy solutions to combat misinformation and fear-mongering in criminal justice policy.

R STREET POLICY STUDY NO. 213

Washington, DC: R Street, 2020. 14p.

By Fredrik Sivertsson, Christoffer Carlsson, Ylva B. Almquist, Lars Brännström

Aim

The current study explores heterogeneity in the aggregate age-crime curve. This is achieved by analyzing to what extent there is empirical support for the existence of pivotal typologies in developmental and life-course criminology, as well as whether there is any heterogeneity in trajectories among adult-onset offenders (first recorded for crime at age 25 or later).

Methods

Data were drawn from a population-representative birth cohort of 14,608 males and females, followed prospectively in registers from age nine to 64. Trajectories of antisocial and criminal behavior were identified by means of group-based trajectory modelling.

Results

A small group with a high prevalence of crime across the life course, among both males and females, was found. Furthermore, a large proportion of offenders were adult-onset offenders, and there was meaningful heterogeneity in their criminal trajectories. However, the data did not lend much support to the hypothesized phenomenon of late-blooming.

Conclusion

There is meaningful heterogeneity in the aggregate age-crime curve, including trajectories that resonate fairly well with predictions derived from Moffitt's taxonomy. Nevertheless, there are firm reasons for theorizing proximate causes for the onset and continuation of crime beyond emerging adulthood.

Journal of Criminal Justice, Volume 91, March–April 2024, 102155, 24 pages

By Sara Waring,  Adrianna Fusco-Maguire,  Caitlin Bromley,  Bess Conway,  Susan Giles,  Freya O’Brien &  Paige Monaghan 

Some police forces are investing resources into dedicated missing person teams (MPTs) to improve risk assessment and responsibility sharing across partner agencies. This study used police records and interviews with representatives from police and partner agencies in one UK region to provide the first systematic evaluation of the impact of implementing a dedicated MPT on the response to missing children. Results revealed a reduction in reports and change in risk assessment practices post implementation, along with suggestions that the MPT brought about more of a child-centred approach, a pushing back of responsibility to care providers, and greater personalised communication with children and care providers. However, improvements needed to be made to intra- and inter-agency communication, and consideration of resources across shift patterns. Findings pose important implications for informing decisions regarding allocation of finite resources and improving multiagency response to missing children.

Cambridge Journal of Evidence-Based Policing, Dec/ 2023.

By Samira Schreiber, Stephanie Pasternak and Kathryn Gilley, with contributions from Shannon Scully, Jessica Tornabene and Hannah Wesolowski.

   People with mental illness are disproportionately represented in our nation’s criminal justice system. About two in five people who are incarcerated have a history of mental illness.This is twice the prevalence of mental illness within the overall population. These numbers represent real people that our mental health system has failed. Fortunately, we know that diversion from the criminal justice system is possible, and NAMI believes that people with mental illness should be diverted at every possible opportunity and be connected to mental health care. One of the best tools for understanding how communities can divert individuals with mental health and substance use conditions away from criminal justice system involvement is the Sequential Intercept Model (often referred to as SIM).  

  Arlington, VA: NAMI, the National Alliance on Mental Illness, 2024. 28p.

By The Transnational Alliance to Combat Illicit Trade

One of the key underlying conditions that makes countries more vulnerable to illicit trade is corruption, which erodes controls designed to prohibit illegal goods to move across borders, undermines law enforcement operations to detect or interrupt illicit trade, and contributes to impunity of illicit traders. 

A new report from the Transnational Alliance to Combat Illicit Trade (TRACIT) - Money Talks: The Crooked Connection Between Corruption and Illicit Trade - finds that corruption is affecting illicit trade worldwide. There is not a single sector of illicit trade that is not tainted by corruption, including agrifoods, alcohol, IUU fishing, forced labor, timber, or wildlife, pharmaceuticals, pesticides, precious metals, gemstones, tobacco products, petroleum, or counterfeiting. 

Examples of when corruption is encountered during illicit trading include when:

• Border agents and customs officials facilitate the movement of illicit goods.

• Law enforcement officials fail to report or investigate illegal operations, prevent arrests or release suspects.

• Government officials facilitate the fraudulent issuance of permits and licenses, allow quotas to be exceeded or interfere with regulatory inspections.

• Officials involved in the criminal justice process help evidence disappear during prosecutions, delay or drop prosecutions, or to return no convictions in the cases of those who are brought to trial.

• Furthermore, there is a robust correlation between corruption (as measured by Transparency International’s CPI) and illicit trade (as measured by the EIU’s Global Illicit Trade Environment Index).

The report finds that any successful steps to mitigate illicit trade will necessarily require strong and targeted measures to mitigate corruption and prevent corrupt actors from compromising the integrity of the global supply chain.

Based on the findings of the report, TRACIT has formulated a set of policy recommendations aimed at facilitating an effective response to corruption in the context of illicit trade. These recommendations provide a “checklist” of fundamental measures that governments are encouraged to implement to improve their ability to defend against the wider societal harms of illicit trade, with a particular emphasis on addressing the enabling role of corruption in perpetuating illicit supply chains.

New York: TRACIT, 2024. 72p.

By Scarlet Neath,  Rashad James,  Charlotte Resing, 

Nationally, at least 12% of all police arrests are for possessing, selling, or making illicit drugs. Despite using and selling illicit drugs at similar rates as White people do, Black people are more likely to be arrested, incarcerated, and reported to law enforcement by medical professionals for substance use. Decades of criminalizing certain substances as a crime-control tactic has failed to achieve its goal of eliminating drug use and instead contributed to profound stigma and fear of punishment that prevents people from accessing treatment and support. It has also resulted in the proliferation of smaller, more potent versions of illicit drugs–like fentanyl–which have exacerbated the opioid crisis in recent years. In 2021, drug overdose deaths reached a record high of 106,699 people, and overdose from synthetic opioids such as fentanyl is now a leading cause of death for adults ages 18 to 45. Because of systemic inequities, including in health care access and the criminal legal system, Black and Native people are experiencing even higher increases in overdose rates than White people are. A public safety approach to substance use, in contrast, means ending the widespread, racist, arbitrary, and ineffective 

criminalization of certain drugs. It requires fully investing instead in equitable and accessible systems of care to prevent and reduce the harms associated with substance use, including consistently offering services that recognize continued, moderated use as a common and acceptable feature of recovery. Laws prohibiting the use of certain drugs (including alcohol at one time) have been repeatedly enacted, fueled by racist narratives about the dangerous behavior of particular groups of people due to their substance use, including German, Irish, and Chinese immigrants; Black men; and communists. The Controlled Substances Act of 1970 created the current framework stipulating which substances are deemed illicit under federal law. It also established categories for regulating substances based on the perception about potential for abuse and whether the substance has any medical benefits. Notably, alcohol and tobacco were excluded despite high potential for dependency. The enforcement of drug laws increased dramatically after 1971, when President Nixon declared the war on drugs,10 which an advisor later said was an effort to criminalize and vilify Black people and war protesters. After this announcement, the government embarked on a decades-long trend of prioritizing and increasing funding for enforcement that is still ongoing. For example, the U.S. government spent approximately $2.8 billion on drug enforcement in 1981, adjusted for inflation, compared to $19.3 billion in 2023. This immense federal funding has enabled wide and inequitable enforcement of drug laws by local law enforcement agencies, funneling millions of people–especially Black and Latino men–into carceral systems and saddled them with criminal records that affect their future eligibility for housing, employment, voting, and education while undermining community health In 2022, law enforcement made more than 600,000 arrests for drug possession nationally. Black people are almost twice as likely as White people to be arrested for drug offenses. The war on drugs is widely recognized as a primary contributor to mass incarceration, racial disparities in incarceration rates, and militarized policing tactics. .From 1980 to 2011, the average federal prison sentence for a drug offense increased 36%, and similarly, the state incarceration rate for drug offenses increased nearly tenfold.  As of 2019, Black people were 3.6 times more likely than White people to be incarcerated in state prisons for a drug offense.  In addition to being a primary driver of mass incarceration, these efforts have failed to eliminate drug use–and its associated harms–from our society. Instead, over the past several decades of heavy enforcement, illegal drug prices have declined and the annual number of overdose deaths has risen fivefold since 1999. From 2019 to 2020, the latest year of data, drug overdose rates rose 22% among White people, 39% among Native people, and 44% among Black people. These disparities are not fully explained by differences in substance use patterns. Instead, Black communities face heightened barriers to accessing care due to reasons including criminalization, mistrust of the medical system, and lack of access to certain evidence-based treatments.  According to recent data, Black people who died from overdose had the lowest rate of previous substance use treatment.

West Hollywood, CA: Center for Policing Equity , 2024. 40p. 

By Cecilia Esterline

Key takeaways - The Heritage Foundation’s Project 2025 is the policy playbook for a second Trump administration, and its impacts on immigration would be far more complex and destructive than previously reported. It isn’t simply a refresh of first-term ideas, dusted off and ready to be re-implemented. Rather, it reflects a meticulously orchestrated, comprehensive plan to drive immigration levels to unprecedented lows and increase the fed eral government’s power to the states’ detriment. These proposals circumvent Congress and the courts and are specifically engineered to dismantle the foundations of our immigration system. The most troubling proposals include plans to: • Block federal financial aid for up to two-thirds of all American college students if their state permits certain immigrant groups, including Dreamers with legal status, to access in-state tuition. • Terminate the legal status of 500,000 Dreamers by eliminating staff time for reviewing and process ing renewal applications. • Use backlog numbers to trigger the automatic suspension of application intake for large categories of legal immigration. • Suspend updates to the annual eligible country lists for H-2A and H-2B temporary worker visas, thereby excluding most populations from filling critical gaps in the agricultural, construction, hospi tality, and forestry sectors. • Bar U.S. citizens from qualifying for federal housing subsidies if they live with anyone who is not a U.S. citizen or legal permanent resident. • Force states to share driver’s licenses and taxpayer identification information with federal authorities or risk critical funding. These proposals, along with the others discussed herein, mark a significant divergence from traditional conservative immigration priorities like promoting merit-based immigration, fostering assimilation, and enhancing interior enforcement. Instead, they are designed to cripple the existing immigration system without regard for the extraordinarily harmful effects on the health and wealth of our country. They would weaken our nation’s prosperity and security and undermine the vitality of our workforce, with far-reaching consequences for future generations of Americans. 

Washington, DC:  Niskanen Center , 2024. 17p

By Brittany Torrez, LaStarr Hollie, Jennifer Richeson, and Michael Kraus

Despite a checkered racial history, people in the US generally believe the nation has made steady, incremental progress toward achieving racial equality. In this paper, the researchers investigate whether this US racial progress narrative will extend to how the workforce views the effectiveness of organizational efforts surrounding diversity, equity, and inclusion (DEI). Across three studies (N = 1,776), they test whether Black and White US workers overestimate organizational racial progress in executive representation. Torrez, Hollie, Richeson, and Kraus also examine whether these misperceptions, surrounding organizational progress, drive misunderstandings regarding the relative ineffectiveness of common organizational diversity policies. Overall, they find evidence that US workers largely overestimate organizational racial progress, believe that organizational progress will naturally improve over time, and that these misperceptions of organizational racial progress may drive beliefs in the effectiveness of DEI policies.

Evanston, IL: Northwestern University, Institute for Policy Research, 2024. 49p.

By, Louis Favril,, Josiah D Rich, Jake Hard, and Seena Fazel

   Summary Background People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. Methods In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre registered with PROSPERO, CRD42023404827. Findings Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9–12·8) for major depression, 9·8% (6·8–13·2) for post-traumatic stress disorder, and 3·7% (3·2–4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0–26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5–46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0–20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small study effects. Interpretation People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health.

Lancet Public Health 2024; 9: e250–60

By Sara Naicker

Data analysis shows how violence in childhood is connected to health and social problems almost three decades later.

This policy brief uses the adverse childhood experiences framework, coupled with data from the Birth to Thirty cohort study, to show the impact of violence and adversity on the lives of South Africans. It connects violence and adversity in childhood to health and social problems almost three decades later. Understanding, foregrounding and addressing the effects of violence and adversity are essential for national development

Policy Brief 174

South Africa: Institute for Security Studies, 2022. 16p.

By Chris O'Leary, Rob Ralphs, Jennifer Stevenson, Andrew Smith, Jordan Harrison, Zsolt Kiss, Harry Armitage

Background

Homelessness is a traumatic experience, and can have a devastating effect on those experiencing it. People who are homeless often face significant barriers when accessing public services, and have often experienced adverse childhood events, extreme social disadvantage, physical, emotional and sexual abuse, neglect, low self-esteem, poor physical and mental health, and much lower life expectancy compared to the general population. Rates of problematic substance use are disproportionately high, with many using drugs and alcohol to deal with the stress of living on the street, to keep warm, or to block out memories of previous abuse or trauma. Substance dependency can also create barriers to successful transition to stable housing.

Objectives

To understand the effectiveness of different substance use interventions for adults experiencing homelessness.

Search Methods

The primary source of studies for was the 4th edition of the Homelessness Effectiveness Studies Evidence and Gaps Maps (EGM). Searches for the EGM were completed in September 2021. Other potential studies were identified through a call for grey evidence, hand-searching key journals, and unpacking relevant systematic reviews.

Selection Criteria

Eligible studies were impact evaluations that involved some comparison group. We included studies that tested the effectiveness of substance use interventions, and measured substance use outcomes, for adults experiencing homelessness in high income countries.

Data Collection and Analysis

Descriptive characteristics and statistical information in included studies were coded and checked by at least two members of the review team. Studies selected for the review were assessed for confidence in the findings. Standardised effect sizes were calculated and, if a study did not provide sufficient raw data for the calculation of an effect size, author(s) were contacted to obtain these data. We used random-effects meta-analysis and robust-variance estimation procedures to synthesise effect sizes. If a study included multiple effects, we carried out a critical assessment to determine (even if only theoretically) whether the effects are likely to be dependent. Where dependent effects were identified, we used robust variance estimation to determine whether we can account for these. Where effect sizes were converted from a binary to continuous measure (or vice versa), we undertook a sensitivity analysis by running an additional analysis with these studies omitted. We also assessed the sensitivity of results to inclusion of non-randomised studies and studies classified as low confidence in findings. All included an assessment of statistical heterogeneity. Finally, we undertook analysis to assess whether publication bias was likely to be a factor in our findings. For those studies that we were unable to include in meta-analysis, we have provided a narrative synthesis of the study and its findings.

Main Results

We included 48 individual papers covering 34 unique studies. The studies covered 15, 255 participants, with all but one of the studies being from the United States and Canada. Most papers were rated as low confidence (n = 25, or 52%). By far the most common reason for studies being rated as low confidence was high rates of attrition and/or differential attrition of study participants, that fell below the What Works Clearinghouse liberal attrition standard. Eleven of the included studies were rated as medium confidence and 12 studies as high confidence. The interventions included in our analysis were more effective in reducing substance use than treatment as usual, with an overall effect size of –0.11 SD (95% confidence interval [CI], −0.27, 0.05). There was substantial heterogeneity across studies, and the results were sensitive to the removal of low confidence studies (−0.21 SD, 95% CI [−0.59, 0.17] − 6 studies, 17 effect sizes), the removal of quasi-experimental studies (−0.14 SD, 95% CI [−0.30, 0.02] − 14 studies, 41 effect sizes) and the removal of studies where an effect size had been converted from a binary to a continuous outcome (−0.08 SD, 95% CI [−0.31, 0.15] − 10 studies, 31 effect sizes). This suggests that the findings are sensitive to the inclusion of lower quality studies, although unusually the average effect increases when we removed low confidence studies. The average effect for abstinence-based interventions compared to treatment-as-usual (TAU) service provision was –0.28 SD (95% CI, −0.65, 0.09) (6 studies, 15 effect sizes), and for harm reduction interventions compared to a TAU service provision is close to 0 at 0.03 SD (95% CI, −0.08, 0.14) (9 studies, 30 effect sizes). The confidence intervals for both estimates are wide and crossing zero. For both, the comparison groups are primarily abstinence-based, with the exception of two studies where the comparison group condition was unclear. We found that both Assertative Community Treatment and Intensive Case Management were no better than treatment as usual, with average effect on substance use of 0.03 SD, 95% CI [−0.07, 0.13] and –0.47 SD, 95% CI [−0.72, −0.21] 0.05 SD, 95% CI [−0.28, 0.39] respectively. These findings are consistent with wider research, and it is important to note that we only examined the effect on substance use outcomes (these interventions can be effective in terms of other outcomes). We found that CM interventions can be effective in reducing substance use compared to treatment as usual, with an average effect of –0.47 SD, 95% CI (−0.72, −0.21). All of these results need to be considered in light of the quality of the underlying evidence. There were six further interventions where we undertook narrative synthesis. These syntheses suggest that Group Work, Harm Reduction Psychotherapy, and Therapeutic Communities are effective in reducing substance use, with mixed results found for Motivational Interviewing and Talking Therapies (including Cognitive Behavioural Therapy). The narrative synthesis suggested that Residential Rehabilitation was no better than treatment as usual in terms of reducing substance use for our population of interest.

Authors' Conclusions

Although our analysis of harm reduction versus treatment as usual, abstinence versus treatment as usual, and harm reduction versus abstinence suggests that these different approaches make little real difference to the outcomes achieved in comparison to treatment as usual. The findings suggest that some individual interventions are more effective than others. The overall low quality of the primary studies suggests that further primary impact research could be beneficial.

Campbell Systematic Reviews, Volume 20, Issue , June 2024, 65 pages

By Daniel Rosenblum, Jeffrey Ondocsin, Sarah G. Mars, Dennis Cauchon, Daniel Ciccarone

We investigate the relationship between the supply of methamphetamine and overdose death risk in Ohio. Ohio and the overall US have experienced a marked increase in overdose deaths from methamphetamine combined with fentanyl over the last decade. The increasing use of methamphetamine may be increasing the risk of overdose death. However, if people are using it to substitute away from more dangerous synthetic opioids, it may reduce the overall risk of overdose death.

Methods

Ohio’s Bureau of Criminal Investigation’s crime lab data include a detailed list of the content of drug samples from law enforcement seizures, which are used as a proxy for drug supply. We use linear regressions to estimate the relationship between the proportion of methamphetamine in lab samples and unintentional drug overdose death rates from January 2015 through September 2021.

Results

Relatively more methamphetamine in crime lab data in a county-month has either no statistically significant relationship with overdose death rates (in small and medium population counties) or a negative and statistically significant relationship with overdose death rates (in large population counties). Past overdose death rates do not predict future increases in methamphetamine in crime lab data.

Conclusions

The results are consistent with a relatively higher supply of methamphetamine reducing the general risk of overdose death, possibly due to substitution away from more dangerous synthetic opioids. However, the supply of methamphetamine appears unrelated to the past illicit drug risk environment.

  Drug and Alcohol Dependence Reports, (2024), 31 pages