The twenty-five-year epidemic of opioid misuse in the United States has taken at least 750,000 lives
through overdose. We undertook to learn whether this toll might have been accompanied by an
increase in violence resulting from growth in the illicit opioid market, which, like most illicit drug
markets, includes a risk of violence due to conflicts among sellers and between sellers and buyers.
We found that increases in activity in this market were associated with—and arguably caused—increased levels of homicide.
Using county opioid overdose rates as a measure of levels of transactions in the illicit market, we
looked for an association between those rates and county homicide rates between 1999 and 2015. As
the epidemic has been especially intense in the White U.S. population, we conducted separate analyses for the White and Black populations. We also compared Appalachian counties to the rest of the
country, as Appalachia has been particularly hard hit by the crisis.
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- United States of America