Methodology and data sources

Case Study Methodology

Between March and June 2020, Vera researchers conducted phone and video interviews with local experts in Bernalillo County and Rio Arriba County in New Mexico and Haywood County and Durham County in North Carolina. The sites were chosen based on criteria relating to trends in overdose rates and jail incarceration rates, the presence of clear programmatic or policy innovations, diversity in geographic location, demographic composition of the population, and ability to access key stakeholders.

Before selecting counties within the states, researchers performed background calls with state-level experts on substance use, overdose death, behavioral health, jail incarceration, and relevant state-level policy and programs for both states. Recommendations from state-level experts helped to inform selection of counties for deeper case studies. In New Mexico, Vera researchers spoke with six state-level experts, including harm reduction experts affiliated with the New Mexico Department of Health, a diversion program developer and evaluator, and a member of the state’s chapter of the American Civil Liberties Union. In North Carolina, Vera researchers spoke with six state-level experts, including researchers from the University of North Carolina at Chapel Hill (UNC–CH) and the University of Western North Carolina, members of the North Carolina Harm Reduction Coalition (NCHRC), and the North Carolina Department of Health and Human Services.

Researchers completed a total of 17 individual or group interviews, eight in New Mexico and nine in North Carolina. People acting in a personal capacity received a $50 gift card for participating in an interview. Two Vera researchers conducted each interview and analyzed transcripts and notes for themes.

The people Vera interviewed in Bernalillo County included a local prosecutor, a public health expert involved in local drug policy work, a county behavioral health administrator, and a senior staff member from a health and social services organization to better understand how stakeholders at the county level are interpreting and addressing these trends. In Rio Arriba county, the people interviewed included a justice reform advocate, a local judge, a coordinator for the county’s Law Enforcement Assisted Diversion (LEAD) program, and a founder of a community organization.

The people Vera interviewed in Haywood County included members of the Haywood County Sheriff’s Office, two NCHRC staff, and two NCHRC syringe services program participants and peer distributors. People interviewed in Durham County included three members of the Durham County Sheriff’s Office, including the sheriff; a UNC–CH professor of family medicine who founded the North Carolina Formerly Incarcerated Transition program; and a program manager with NCHRC.

Data Sources

  • Jail data: All data on jail incarceration was retrieved from the Vera Trends public GitHub, as of the update on September 17 2020,
  • State and national overdose deaths: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, “Mortality,” database (CDC WONDER) (Washington, DC: US Department of Health and Human Services),
    • National trends between the years of 1979 and 2018, and national trends in overdose death by race and ethnicity were provided by Professor Matthew Kiang. In the spring of 2020, Professor Kiang provided authors with an updated analysis of the following paper: Monica J. Alexander, Matthew V. Kiang, and Magali Barbieri, “Trends in Black and White Opioid Mortality in the United States, 1979-2015,” Social Epidemiology, 29, no. 5 (2018), 707-715. The updated analysis provides the overall standard overdose death rate from 1979 to 2018, and the standard overdose death rates by race and ethnicity from 2000 to 2018. The data used in Professor Kian’s analysis is available here:
  • County overdose death estimates: L.M. Rossen, B. Bastian, M. Warner, et al. "Drug Poisoning Mortality: United States, 1999–2018," database (Washington, DC: National Center for Health Statistics, 2020),
    • Note that trends in jail incarceration and overdose death shown in this report by urbanicity are calculated by taking the average of counties by urbanicity. Previous Vera publications have presented similar information on jails by taking the sum of all counties. As such, numbers will vary.
  • Drug-induced homicide case filing data: Health in Justice Action Lab, “Drug Induced Homicide,” database (Boston: Northeastern University School of Law),
    • Although many states do not have explicit drug-induced homicide laws, case data reviewed by Northeastern University’s Health in Justice Action Lab may identify cases filed in which a person is charged with homicide related to an overdose death, regardless of the presence of a statewide law.
  • State laws pertaining to naloxone access, Good Samaritan 911 protections, and Medicaid coverage: Center for Public Health Law Research, Temple University Beasley School of Law, "Prescription Drug Abuse Policy System (PDAPS)," accessed December 18, 2019,