Implementation of a Statewide Fentanyl Possession Law and Opioid-Related Overdose Deaths.

Importance: In 2022, Colorado passed legislation making possession of small amounts of fentanyl, a high-potency synthetic opioid, a felony. Whether the Colorado law affected opioid overdose fatalities and whether those effects differed by racial and ethnic subgroups is unknown.

Objective: To estimate the association between the change in criminal penalties for fentanyl possession with opioid-related overdose deaths (OODs) in Colorado.

Design, Setting, And Population: Serial cross-sectional study comparing OODs among adults (≥18 years) who died of an overdose and population estimates before and after Colorado House Bill (HB) 22-1326 was enacted in July 2022 (January 2018-November 2023) using autoregressive integrated moving averages (ARIMA) model time series forecasting. Monthly OOD rates per 100 000 residents were calculated using state population estimates from the American Community Survey 5-Year Data and the Colorado Department of Local Affairs State Demography Office. Overdose death rates were calculated separately by racial and ethnic group (Hispanic, non-Hispanic Black, and non-Hispanic White). Data were analyzed from January 2018 to 2023.

Exposure: Enactment of HB 22-1326 changed the legal penalty for possession of any drug weighing 1 g to 4 g that contained any amount of fentanyl from a misdemeanor to a level-4 drug felony punishable by up to 180 days in jail and up to 2 years of probation.

Main Outcome: The difference between expected and observed OOD rates following the enactment of increased criminal penalties.

Results: A total of 7099 OODs were analyzed (1798 Hispanic [25.3%], 451 Non-Hispanic Black [6.4%], and 4170 Non-Hispanic White [58.7%], 680 other [9.5%] and not included in the race and ethnicity categories). OODs increased across the study period in Colorado from 20.46 per 100 000 adults in January 2018 to 37.78 per 100 000 adults in November 2023. Among different racial and ethnic groups, the non-Hispanic Black population had the highest increase in OODs (9.3 per 100 000 in 2018 to 56.9 per 100 000 in 2023) followed by the Hispanic population. There was no difference between the observed and expect overdose deaths for the overall population following the enactment of HB 22-1326. However, there were significant increases in 4 of 13 months after policy implementation among the non-Hispanic Black population.

Conclusions And Relevance: The results of this serial cross-sectional study suggest that increased criminal penalties for fentanyl possession did not change preexisting trends of OODs in Colorado and may have been associated with an increase in opioid overdoses in the Black population. These results should be interpreted in light of increasing opioid overdose rates in Black populations nationally during the study period.