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The alarming rise in drug overdoses has been uneven in the U. In a new study , we examine whether the presence of alcohol outlets contributes to neighborhood disparities in drug overdoses, and whether alcohol outlets that sell drug paraphernalia are associated with neighborhood overdose rates. The study, published in International Journal of Drug Policy , found that each additional off-premise alcohol outlet in a Baltimore City neighborhood was associated with a Off-premise settings include liquor and package stores and taverns that sell liquor, beer, and wine. In contrast, on-premise alcohol outlets restaurants, bars, hotels, and entertainment venues were not significantly associated with the neighborhood overdose rate when off-premise outlets were also present in a neighborhood. Why did we focus on alcohol outlets? A large body of literature has linked off-premise alcohol outlets with drinking problems, crime, and violence. Unlike on-premise outlets, off-premise alcohol outlets can sell alcoholic beverages in large quantities to patrons who are unmonitored by servers and often drink in nearby, uncontrolled environments, such as motor vehicles, parking lots, or street corners. Consequently, off-premise outlets are often surrounded by signs of alcohol consumption and signals of social disorganization, such as empty or broken bottles, loiterers, and publicly intoxicated patrons. Because these areas are often located in communities with low social capital and collective efficacy, they may be opportune locations for illegal drug sales. More alcohol outlets are generally found in economically depressed, predominantly-minority neighborhoods, exacerbating health disparities in these communities. To further examine the connection between alcohol outlets and drug overdoses, we visited every off-premise alcohol outlet in Baltimore City and measured drug paraphernalia items for sale. Paraphernalia included items used to distribute or sell drugs e. We found that as the proportion of off-premise outlets selling drug paraphernalia went up, neighborhood overdose rates went down:. This finding may be counterintuitive. One explanation is that we measured overdose rates by EMS calls, and that might have had an impact. Because drug markets develop around alcohol outlets in low-resource neighborhoods, increased policing of these locations may negatively affect calls for drug overdose. Studies show that drug arrests cluster around alcohol outlets, indicating increased policing around these establishments. In heavily-policed environments, people who use drugs and other bystanders may be wary of calling in the event of an overdose. Even if a bystander has not been using drugs, mistrust of the police and fear of repercussions of police contact, such as lost housing and child custody, social stigma, and repercussions from local drug dealers may deter calls for drug overdose. It is also possible that a different data source such as fatal drug overdoses from a medical examiner case archive might produce different results. This study, to our knowledge, is the first to link off-premise alcohol outlets to drug overdose rates. It suggests that alcohol outlets, particularly those that sell drug paraphernalia, could be community partners for harm reduction strategies, such as naloxone distribution or health communication on drug purity or identifying overdose symptoms. Alcohol outlets may also be potential focal points for community outreach and education campaigns around Good Samaritan Laws to encourage bystander support for drug overdose. Authors include Elizabeth D. Nesoff , Adam J. Milam, Christopher Morrison, Brian W. Weir, Charles C. Branas, Debra M. Amy R. Knowlton, and Silvia S. Print: Print this page. Figure 1. Source: Nesoff et al. Elizabeth D. More on the Opioid Epidemic. Search Search.

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Injury Epidemiology volume 9 , Article number: 17 Cite this article. Metrics details. Substance-related interactions with the criminal justice system are a potential touchpoint to identify people at risk for firearm violence. We used an agent-based model to simulate the change in firearm violence after disqualifying people from owning a firearm given prior alcohol- and drug-related misdemeanors. Disqualification from purchasing firearms for 5 years after an alcohol-related misdemeanor conviction reduced population-level rates of firearm homicide by 1. Disqualification based on a drug-related misdemeanor conviction reduced homicide by 1. Reductions were generally 2 to 8 times larger for agents meeting the disqualification criteria. Denying firearm access based on a history of drug and alcohol misdemeanors may reduce firearm violence among the high-risk group. Enactment of substance use-related firearms denial criteria needs to be balanced against concerns about introducing new sources of disenfranchisement among already vulnerable populations. In , 39, people in the USA died from firearm injuries: Six out of every 10 were suicide deaths, and 3 out of every 10 were homicide deaths. Deaths due to firearms are only one outcome of firearm violence: It is estimated that about , people experience a non-fatal firearm injury per year Gani et al. The burden of morbidity and mortality related to firearms is a public health crisis in the USA and calls for effective, evidence-based legislation to stem the tide of firearm injury are growing Barry et al. Prohibiting access to firearms by groups of people at high risk of committing violence against themselves or others is one of the leading strategies to prevent firearm violence Siegel et al. Notably, federal law does not prohibit people who misuse alcohol from obtaining firearms Branas et al. While limited data are available on the effectiveness of specific firearms denial criteria, and implementation of denial criteria varies across states, prior research suggests denying access to firearms to persons convicted of violent misdemeanors Wintemute et al. Our previous simulation study indicates that denying firearm purchases based on psychiatric disorders would reduce suicide among those denied firearms but would have varying impacts on population rates of firearm suicide depending on the prevalence of disqualification criteria Keyes et al. Heavy substance use is one of the strongest predictors of future firearm violence Friedman ; Goldstein et al. In the absence of actual cases of implementation of specific alcohol- and controlled substance-related denial criteria, we simulated the potential impact that a range of firearms denial criteria based on substance-related interactions with the criminal justice system could have on rates of firearm homicide and suicide. We used agent-based models and the best available data to simulate firearm purchase restrictions based on alcohol- and controlled substance-related misdemeanors in New York City NYC. Simulated criteria included: 1 at least one alcohol-related misdemeanor conviction; 2 at least one alcohol-related arrest; 3 at least one drug misdemeanor conviction; and 4 at least one drug arrest. Examining this range of criteria allowed us to ask how expansive criteria would have to be to reduce population-level rates of firearm violence. We developed an agent-based model ABM simulating the dynamic processes contributing to firearm homicide and suicide among adults in NYC, including calibrating firearm ownership and carrying, drug and alcohol use and use disorders, substance and violent-related arrests and convictions, and the broader range of firearm-related outcomes such as assault. Data from NYC sources were used to parameterize and calibrate the model when possible; when NYC data were unavailable, national or other community-based data were used see data sources in Additional file 1 : Table A1. Key components of the model are summarized below. The year was chosen because the data used to parameterize agent behaviors were collected from the earlys through When deriving probabilities from national data, we limited the data sample to those living in Metropolitan Statistical Areas to best represent the NYC population. Based on empirical social network literature Tracy et al. Agents were also embedded in neighborhoods with characteristics of their own, which influenced agent behavior and vice versa. These other neighborhood components e. The model proceeded in discrete annual timesteps. Within each timestep, a series of modules processed in the following order: 1 aging, 2 death and rebirth, 3 recalculations of agent characteristic variables, including firearm ownership and substance use, 4 movement to a new location, 5 potential violent victimization and perpetration, homicide and suicide, 6 actual violent incidents, homicides, and suicides, and 7 arrests and sentencing see Additional file 1 : Figure A3 in Appendix 1 for a flow diagram depicting the processes at each step of the model. Within each module, agents and neighborhoods were processed in sequential order, except for the occurrence of actual violent incidents, for which potential perpetrators were randomly ordered when seeking out potential victims to ensure that all potential perpetrators were given an opportunity to commit violence throughout the model run. The pertinent information for these analyses is described below. A more in-depth description can be found in Additional file 1 : Online Appendix. Agents who died were replaced with adult agents. The model defined firearm ownership as the legal purchase of a gun and carrying represented access to a legally owned or illicit firearm that can be carried. In this model, carrying a firearm included illegal firearm ownership, thus firearm carrying did not solely depend on ownership but was positively associated with it. Once an agent was convicted of a felony, they could no longer own a firearm. If they owned a firearm at the time of conviction, it was removed. However, they could still carry a firearm. Probabilities of firearm ownership and carrying were calibrated from the National Comorbidity Study Replication NCS-R , a nationally representative survey of US adults carried out between and Kessler and Merikangas Ownership and carrying were calibrated separately. Firearm carrying in the absence of ownership was used to represent the illicit firearms market as well as trading firearms outside of the legal market. Probabilities for each parameter were calculated based on sociodemographic characteristics, current drug use and alcohol use, alcohol and drug use disorders, history of violent victimization and perpetration, seven mental health disorders antisocial behavior ASB disorder, generalized anxiety disorder GAD , intermittent explosive disorder IED , major depressive disorder MDD , mania, posttraumatic stress disorder PTSD , and psychosis , overnight hospitalization for a mental health disorder, and suicidal ideation and attempt. An agent's history of ownership and carrying also predicted current ownership, and current ownership also predicted carrying status. An agent could use a firearm for a homicide or suicide if they had a friend who owned or carried a firearm. Agents could be alcohol and drug users as well as diagnosed with a substance use disorder. Probabilities were calculated based on sociodemographic characteristics, current firearm ownership and carrying statuses, current drug use, and history of alcohol use, drug use, alcohol and drug use disorders, violent victimization and perpetration, and the seven mental health disorders listed above. Agents were also assigned a probability of having an alcohol use disorder. Criteria for the probability calculations were the same as for drinking status. Agents were assigned a probability of using drugs based on NCS-R data Kessler and Merikangas , reflecting the use of cannabis, cocaine any form , prescription drugs without being prescribed i. Probabilities were calculated based on the same criteria as drinking status. Similarly, agents were assigned a probability of having drug use disorder and were assigned to have a drug use disorder only if they also used drugs. Suicide was influenced by history of suicide ideation and suicide attempt. Probabilities of suicidal ideation and attempt were dependent on sociodemographic characteristics, current firearm ownership and carrying statuses, current alcohol and drug use Blanco et al. Disorders Blanco et al. A suicide death was determined to be firearm-related if the agent owned, carried, or had access to a firearm through their social network. At each timestep, agents were able to be violent victims or violent perpetrators. Probabilities of violent victimization and perpetration were calculated from NCS-R Kessler and Merikangas dependent on sociodemographic characteristics, prior history of violent perpetration and victimization, history of mental disorder and mental health treatment, drug and alcohol use and use disorders, firearm ownership and carrying statuses, and neighborhood characteristics, and applied to the agents in the agent-based model. Similarly, probabilities were calculated from NCS-R for victimization and perpetration of intimate partner violence IPV , however these probabilities were partially determined by history of IPV. Probabilities were calculated based on race, sex, age, drug use, and heavy drinking status Galea et al. Potential victims and perpetrators both IPV and non-IPV were identified at each timestep, and violent incidents occurred, where a subset of these incidents were homicides. If the victim or perpetrator owned, carried, or had access to a firearm through their social network, the homicide was determined to be firearm-related. Four types of arrests and seven types of convictions were modeled. Agents were assigned probabilities at each timestep of having a violent arrest, an alcohol-related arrest, a drug-related arrest, or another type of arrest. Probabilities were dependent on sociodemographic characteristics i. Based on these probabilities, agents were set to have any of the four types of arrests. Once it was determined if an agent was arrested on a felony or misdemeanor charge, they were assigned a probability of conviction based on DCJS data, and specific to their race, sex, age, and borough. Agents were assigned a felony conviction, a misdemeanor conviction, or no conviction. Details on incarceration are found in Additional file 1 : Appendix 1. The model implemented several critical features of agent-based models, including collectives, emergence, sensing, decision making, interaction, adaptation, and stochasticity. Collectives were present in the model in the form of agents grouped in social networks, neighborhoods, and police patrol areas. Certain events, such as violent incidents or incarceration, emerged from the behaviors and interactions of agents, which in turn were influenced by the characteristics of their neighborhoods and the presence of police officers nearby. Agent decision making , including enacting violence and moving, depended on their past experiences and own characteristics. Violence only occurred in the model if two agents directly interacted in the physical space. Consistent with our prior work Keyes et al. Agents who had not already been victimized at that timestep were matched to a perpetrator unless a police officer was present within a 2-cell radius of the victim, in which case the potential victim was protected from violence. An agent involved in a violent incident had increased probabilities of being involved in future violent incidents, experiencing mental health issues, and inflicting self-harm in subsequent timesteps, which exemplifies the influence of violent involvement on re-victimization re-perpetration, and future psychological distress Keyes et al. Lastly, stochasticity was used in assigning agent characteristics and behaviors at model initialization and throughout the model runs. As a result, the population composition varied slightly across model runs, but population patterns of movement, drinking status, and violence matched expected estimates. The ABM estimates were derived using a well-established two-step process. First, during model calibration, ABM estimates were compared to empirical data on total and neighborhood-specific population composition. An iterative process Jaffe et al. Second, during the intervention scenarios, ownership prohibitions were implemented based on four criteria: 1 alcohol-related misdemeanor conviction, 2 alcohol-related arrest, 3 drug-related misdemeanor conviction, and 4 drug-related arrest. Each year, an agent could meet disqualification criteria, and a 5 or 10 year prohibition would begin. Agents meeting criteria for each prohibition were restricted from gun ownership, their firearm would be removed, and they could not legally purchase a gun for the prohibition period; gun carrying remained possible for prohibited agents and was calibrated in the model as described above. For each of the four criteria, three interventions were implemented: a Firearms were removed for five years after one event, b firearms were removed for ten years after one event, and c firearms were removed for ten years after two or more of the same event happened within a 5-year period. To examine the robustness of our results, we repeated the analyses in two ways, 1 decreasing the base rate of firearm ownership and 2 adjusting the social network influence on violence. First, the national estimate from NCS-R Table 1 describes the distribution of demographics and key parameters of interest from the model at baseline and compares these distributions to empirical data sources. The simulated estimates were generally comparable to those observed in the empirical data. We first tested whether substance-related firearm ownership disqualifications reduced firearm-related homicide and suicide rates in the general population see Table 2. The base rate of firearm-related homicide was 4. Across the four disqualification criteria, a year intervention was more effective at decreasing firearm-related homicide and suicide than a 5-year intervention after a single event. When restricting firearm ownership based on an alcohol-related misdemeanor conviction, firearm-related homicide decreased by 1. Under this same restriction, firearm-related suicide decreased by 3. Disqualification based on any alcohol-related arrest produced a similar reduction in homicide than restrictions based on a misdemeanor conviction. Firearm-related homicide decreased by 1. Under this same restriction firearm-related suicide decreased by 3. At the population level, drug-related firearm disqualification showed larger decreases in firearm-related homicide and suicide than alcohol-related restrictions. Firearm disqualification based on a drug-related misdemeanor conviction reduced firearm-related homicide by 1. Under this same restriction, firearm-related suicide decreased by 4. When the criteria expanded to any drug-related arrest, the decrease in homicide and suicide almost doubled. Firearm-related homicide decreased by 4. Under this same restriction, firearm-related suicide decreased by 8. Implementing a year firearms disqualification after the occurrence of two events in 5 years was less effective at reducing firearm-related homicide and suicide at the population level than restricting firearms after a single event. Firearm-related suicide decreased by 2. Firearm disqualification after two drug misdemeanor convictions in 5 years reduced firearm-related suicide by 2. We examined the impact these interventions could have on homicide and suicide rates within the high-risk groups that were disqualified from purchasing firearms Table 3. Base rates were determined by calculating firearm-related homicide and suicide rates among agents who had ever had a misdemeanor conviction or an arrest or had ever had two events in a 5-year period. Similar to the impact at the population level, disqualifications after a single event were more effective with a year intervention than a 5-year intervention. Among agents who were ever convicted of an alcohol-related misdemeanor, firearm-related homicide decreased by 8. Among agents who ever had an alcohol-related arrest, firearm-related homicide decreased by At the subpopulation level, drug-related restrictions were not as effective as alcohol-related interventions. Among agents who were ever convicted of a drug-related misdemeanor, firearm-related homicide decreased by 2. Among agents who ever had a drug-related arrest, firearm-related homicide decreased by When examining alcohol-related subpopulations, year firearm restrictions after two events in under 5 years were more effective than restrictions after a single event at reducing firearm-related homicide and suicide at the subpopulation level. Among agents who ever had two alcohol-related misdemeanor convictions in under 5 years, firearm-related homicide decreased by Among agents who ever had two alcohol-related arrests in under 5 years, firearm-related homicide decreased by Among agents who ever had two drug-related misdemeanor convictions in under 5 years, firearm-related homicide decreased by 4. Among agents who ever had two drug-related arrests in under 5 years, firearm-related homicide decreased by 5. As we found in our main results, drug-related interventions were more effective than alcohol-related interventions at reducing firearm-related homicide and suicide at the population level Additional file 2 : eTable 1. The effects at the subpopulation level among high-risk groups also replicated our main results, where firearm-related homicide and suicide had larger decreases in the alcohol-related subgroups than the drug-related subgroups Additional file 2 : eTable 2. As can be seen in Additional file 2 : eTables 3—6, drug-related interventions were more effective than alcohol-related interventions among the total population, and in subgroup analyses there were larger decreases in the alcohol-related subgroups than the drug-related subgroups. Findings from our agent-based model suggest that denial of firearm purchases based on an alcohol- and drug-related misdemeanor conviction may produce a small reduction in population-level rates of firearm homicide and suicide, with the largest reduction resulting from firearm purchase denials due to drug-related misdemeanor convictions. At the same time, denial of firearm purchases may have a sizable impact on rates of firearm homicide and suicide among the subgroup of people meeting the denial criteria. Within these subpopulations, the greatest reduction in firearm homicide and suicide was found among people with a prior history of alcohol misdemeanors. Overall, denial of firearm purchases based on alcohol- and drug-related misdemeanor convictions produced a markedly larger reduction in rates of firearm suicide rates compared to firearm homicide. Expansion of denial criteria to people with a history of drug-related arrests could double the reduction in rates of firearm homicide and suicide among the general population, as well as among people with a history of drug misdemeanor arrests. Firearms denial criteria based on a history of alcohol-related misdemeanor convictions are projected to produce small reductions in population-level rates of firearm homicide and suicide. However, disqualifications based on alcohol-related misdemeanor convictions have the potential to produce a larger decrease among those convicted, particularly in the risk of suicide. The substantially reduced risk of suicide within the high-risk group is supported by prior research. In particular, the firearm denial criteria raises barriers to the lethal means needed for a firearm suicide, likely overcoming the particularly strong relationship between heavy alcohol use and suicide Branas et al. The minimal shift in population-level rates of firearm homicide following the simulated denial of the right to purchase firearms based on a prior history of alcohol-related misdemeanor convictions may be due to the small size of this high-risk group: In our population, only per , had been convicted of an alcohol-related misdemeanor in the past year. The small size of this group is borne out in US data. As with alcohol-related misdemeanor convictions, the study suggested that disqualifying those with drug-related misdemeanor convictions was also associated with a slight reduction in population-level rates of suicide but sizable declines in suicide among those in the high-risk group. In contrast, expanding denials to those with a history of any drug-related arrests would reduce both population-level rates of firearm-related homicide and suicide and produce substantial reductions in firearm violence among those with a history of drug-related arrests. Drug use Kaufman et al. Our model simulated a simplified representation of the processes through which drug and alcohol use could increase the risk for violence by allowing the probability of violent perpetration and victimization to be partly predicted by an alcohol- or drug-related misdemeanor conviction or arrest. Further, alcohol and drug-related misdemeanor convictions and arrest, as well as firearm ownership, predicted which agents would be connected in a social network, and the prior history of violence among members in the network predicted the probability of victimization of each agent, thus simulating the confluence of substance-related interactions with law enforcement and firearm ownership in creating violent social contexts. At a broader level, however, our study findings suggest that regardless of whether there is a causal relationship between substance-related law enforcement interaction and firearm violence, a history of drug-related arrests may function as a useful touchpoint to identify individuals at high risk for firearm violence and that limiting the right to purchase firearms within this group may actually shift population-level rates of firearm violence. Based on the existing evidence reviewed above, the Federal Consortium on Risk Based Firearms Policy recommends disqualifying those with a second drug- or alcohol-related misdemeanor offense from purchasing or possessing firearms. Our simulation study suggests that larger population-level shifts in firearm violence could be produced by disqualifying people from having firearms after the first drug- or alcohol-related conviction or arrest. However, such findings need to be considered alongside potential concerns with such high-risk approaches to addressing firearm violence, including whether targeting such groups may deter them from seeking treatment for substance use disorders, and whether this type of approach limits the rights of already disenfranchised groups. This study used a simulation approach, agent-based modeling, to predict the types of firearms denial criteria with the greatest potential to reduce rates of firearm violence. This approach efficiently combined a wide variety of data sources to provide quantitative estimates that can inform policy. ABMs were particularly suitable for the simulation of firearm violence, as the models incorporated spatial and situational dynamics that lead to the perpetration of violence, and considered how the intersection of law enforcement, social networks, and neighborhood context can shape firearm access and the spread of violent behaviors. The study findings should be considered in light of several limitations. First, the validity of the simulation results depends on the assumptions made about the dynamics of violent behavior in our model, as well as the data we used to calibrate the model. We used NYC Census data, as well as data on NYC convictions, arrests, and mortality, among others, but also had to rely on national data to calibrate firearm ownership and carrying dynamics. Future research will have to test whether findings generalize to different contexts, although our findings do indicate that among the small group of individuals that we could disqualify from purchasing firearms in our model, the reduction in firearm violence was very high. We would expect higher numbers of deaths prevented in places with a higher rate of firearm ownership. Second, this model assumes that all agents who met the disqualification criteria could be identified and disarmed. In reality, identification and enforcement of firearms denial criteria are often low, and legal loopholes reduce the efficacy of these measures. Hence, study findings are likely an upper bound of the potential impact of such firearms denial criteria in our study context. Third, we calibrated the illegal firearm marketplace by allowing agents to carry firearms they did not purchase; as data become available on the illegal marketplace dynamics, these simulations will become more robust. Firearm violence is one of the leading public health problems facing the USA today. Prohibiting access to firearms by high-risk groups is one of the main prevention strategies implemented to address this problem. While federal and state statute language is either absent or can be vague with notable exceptions Carr et al. All data generated or analyzed during this study are included in Additional file 1 : Appendix. Allebeck P, Allgulander C. Psychiatric diagnoses as predictors of suicide. A comparison of diagnoses at conscription and in psychiatric care in a cohort of 50, young men. Br J Psychiatry. Article PubMed Google Scholar. Interpersonal Violence and Illicit Drugs. Vol Accessed November 4, After Newtown—Public opinion on gun policy and mental illness. N Engl J Med. Gang membership, drug selling, and violence in neighborhood context. Justice Q. Article Google Scholar. Mapping common psychiatric disorders: structure and predictive validity in the national epidemiologic survey on alcohol and related conditions. JAMA Psychiat. Alcohol use and firearm violence. Epidemiol Rev. Substance use and intimate partner violence: a meta-analytic review. Psychol Violence. Cardora E. Justice Atlas of Sentencing and Corrections. Published Accessed May 24, A review of legislation restricting the intersection of firearms and alcohol in the US. Public Health Rep. Census Bureau. Firearm Violence Prevention. 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Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol. Short-Term suicide risk after psychiatric hospital discharge. Sharkey P. Stuck in place: urban neighborhoods and the end of progress toward racial equality. Chicago: University of Chicago Press; Book Google Scholar. Firearm-related laws in all 50 US States, — Accessed September 4, Swanson JW. Mental disorder, substance abuse, and community violence: An epidemiological approach. The transmission of gun and other weapon-involved violence within social networks. Mental disorder and violence: Is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol. J Artif Soc Soc Simul. Wintemute GJ. Alcohol misuse, firearm violence perpetration, and public policy in the United States. Prev Med baltim. Subsequent criminal activity among violent misdemeanants who seek to purchase handguns. Effectiveness of denial of handgun purchase to persons believed to be at high risk for firearm violence. Axis I and Axis II disorders as predictors of prospective suicide attempts: Findings from the collaborative longitudinal personality disorders study. J Abnorm Psychol. Analysis of the strength of legal firearms restrictions for perpetrators of domestic violence and their association with intimate partner homicide. Am J Epidemiol. Download references. Ava D. You can also search for this author in PubMed Google Scholar. Each author has seen and approved this manuscript. All authors read and approved the final manuscript. All methods were carried out in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Figure A1 Diagram of relations between agent, social network, and neighborhood characteristics in the agent-based model, Diagram of relationships in ABM. Figure A2 Flow diagram illustrating processes occurring at each step of the model, Diagram of processes in model. Figure A3 , Flow diagram illustrating steps in model initialization, Diagram of model initialization. Table A1 Agent, social network, and neighborhood parameters, values, data sources, and update rules, Model parameters, values, data sources, and update rules. Table A2 Agent-based model initialization parameters and default values, ABM initialization parameters. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Would restricting firearm purchases due to alcohol- and drug-related misdemeanor offenses reduce firearm homicide and suicide? An agent-based simulation. Download citation. Received : 24 November Accepted : 20 May Published : 09 June Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Download ePub. Original Contribution Open access Published: 09 June Would restricting firearm purchases due to alcohol- and drug-related misdemeanor offenses reduce firearm homicide and suicide? Abstract Background Substance-related interactions with the criminal justice system are a potential touchpoint to identify people at risk for firearm violence. Results Disqualification from purchasing firearms for 5 years after an alcohol-related misdemeanor conviction reduced population-level rates of firearm homicide by 1. Conclusions Denying firearm access based on a history of drug and alcohol misdemeanors may reduce firearm violence among the high-risk group. Background In , 39, people in the USA died from firearm injuries: Six out of every 10 were suicide deaths, and 3 out of every 10 were homicide deaths. Methods We developed an agent-based model ABM simulating the dynamic processes contributing to firearm homicide and suicide among adults in NYC, including calibrating firearm ownership and carrying, drug and alcohol use and use disorders, substance and violent-related arrests and convictions, and the broader range of firearm-related outcomes such as assault. Table 1 Annualized estimates of homicide and suicide, substance-related arrests and misdemeanors, and firearm carrying and ownership from the agent-based model and empirical data sources Full size table. Table 2 Simulation of gun-related homicide and suicide in New York City after implementation of substance-related ownership disqualifications, among the total agent population Full size table. Results Model calibration Table 1 describes the distribution of demographics and key parameters of interest from the model at baseline and compares these distributions to empirical data sources. Effects of firearm disqualification on population rates of firearm homicide and suicide We first tested whether substance-related firearm ownership disqualifications reduced firearm-related homicide and suicide rates in the general population see Table 2. Effects of firearm disqualification on rates of firearm homicide and suicide among high-risk groups We examined the impact these interventions could have on homicide and suicide rates within the high-risk groups that were disqualified from purchasing firearms Table 3. Table 3 Simulation of gun-related homicide and suicide in New York City after implementation of substance-related ownership disqualifications, among high-risk groups Full size table. Discussion Findings from our agent-based model suggest that denial of firearm purchases based on an alcohol- and drug-related misdemeanor conviction may produce a small reduction in population-level rates of firearm homicide and suicide, with the largest reduction resulting from firearm purchase denials due to drug-related misdemeanor convictions. Applications of this study Based on the existing evidence reviewed above, the Federal Consortium on Risk Based Firearms Policy recommends disqualifying those with a second drug- or alcohol-related misdemeanor offense from purchasing or possessing firearms. Strengths and limitations This study used a simulation approach, agent-based modeling, to predict the types of firearms denial criteria with the greatest potential to reduce rates of firearm violence. Conclusions Firearm violence is one of the leading public health problems facing the USA today. Availability of data and materials All data generated or analyzed during this study are included in Additional file 1 : Appendix. References Allebeck P, Allgulander C. Article Google Scholar Cardora E. Google Scholar Wintemute GJ. Article Google Scholar Download references. Acknowledgements Not applicable. View author publications. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information. Additional file 1. Additional file 2. About this article. Copy to clipboard. Contact us General enquiries: journalsubmissions springernature.

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