Work in Progress: Studying Death by Distribution
Michele Easter is currently conducting a comprehensive study of “Death by Distribution” prosecutions in North Carolina with co-authors Rita Grunberg, Madeline Stenger, Lindsay Bass-Patel, Jeffrey Swanson, and Abigail Lee (A.B. ’25). Death by Distribution refers to homicide charges to prosecute a lethal overdose, specifically against the person who shared or sold a drug that led to the overdose. These laws are often framed as tools for justice, but their effects on overdose prevention remain open to debate. Currently, there are Death by Distribution laws in 37 states, and legislation was recently introduced in 5 others. Dr. Easter’s project maps out where “Death by Distribution” charges are being prosecuted across North Carolina’s 100 counties from 2013 to 2024.
Drawing on her background in sociology, Dr. Easter seeks to understand the context for these prosecutions and raise awareness of potential impacts on public health and public safety. Her work addresses the underlying question: What is the best approach for individuals whose criminalization stems from untreated health and social needs? Learn more about her research in this Q&A with Dr. Easter as part of our new Work in Progress series.
Why do you think researching “Death by Distribution” laws in North Carolina is especially relevant right now?
Even though opioid deaths have gone down in the last year, they're still incredibly high if you compare them to before the COVID pandemic and also years before that. We were already worried about overdoses before the pandemic, and with the pandemic, rates got really high. So even though there's been a recent decrease, I think it's important to study death by distribution because it's one of the responses that communities have to the crisis, and it may or may not get the results that they're looking for. In fact, the fear of prosecution could discourage people from calling 911 to get help for someone having an overdose, resulting in even more deaths. Our project focused on the least severe type of death by distribution charge, which can apply when people are sharing and using drugs together and one of them dies of an overdose. We compare counties and jurisdictions on their rate of death by distribution charging, meaning, how many prosecutions they had per 1,000 overdose deaths.
What surprised you most when you began analyzing the variation in these prosecutions?
So one thing that I started with was an assumption that if you're a richer county with really good public health, treatment services, and advantages, you're not going to use death by distribution as much, because you think “we have our solution, and it's public health and access to treatment. We have the capacity and resources to help people with substance use problems.” So I thought that would mean that you don't prosecute them as much. And what's interesting is the statute was written with that same rationale. The legislative intent as written into the statute was that “the health system is overburdened by the opioid crisis, so we're going to help out by having this severe law in place.” What we found was that the richer counties were more likely to prosecute death by distribution cases. I think it has to do with the capacity of the local law enforcement to conduct these investigations; they are long and potentially expensive cases to pursue. So it's not like the socioeconomic context just means one thing, such as investment in public health and treatment resources. It could also mean a community has invested in its criminal justice prosecution resources. We saw that association between wealth and prosecution at the county level only, which makes some sense because counties, sheriffs, and cities are carrying out the investigations. We did not see an association between wealth and prosecutions at the district level though. So that was what surprised me, that if anything, it's the richer areas that have more death by distribution prosecutions out of proportion to their overdoses.
Your preliminary findings suggest that poverty and race can play a significant role in where and how these cases are charged—can you explain that relationship?
We don't have access to data about the individuals who are charged. We had just a little bit of information for just a few years about the race, age, sex of people who received these charges, and we don't know how that compares to the person who died of an overdose. There's a lot of concern about how there might be more prosecution if the victim is white, and especially if the person who shared or sold the drug was non-white. Other researchers who've been looking at this have preliminary data suggesting that white victims or decedents are more likely to have death by distribution charges associated with their death. So that's one way race goes into it. But what we found at the county level, was an odd pattern where a very white county is more similar to a very non-white county in have a lower rate of prosecutions per 1,000 overdoses, but then the in-between counties had a higher rate. It makes you wonder, and I feel that we might be able to disentangle that if we had access to the individual-level data, because what if that pattern is driven by differences in the race of the person who died and the person who shared or sold the drug? I don't know. There’s a lack of data.
Did you face any data challenges during your research?
I wish that we had access to individual and case-level data because we don't know if there's unfairness in who's getting charged; in a given county, are there patterns that would make you think maybe there's a race disparity? But we just can't know that. We also can't know what happened after they were charged, and what else were they charged with. Did they have a long history of drug-related convictions , and then they got charged with this? Or did some people without any past issues get prosecuted? So there might be different philosophies of charging in different places, and we just don't know.
How do you hope communities and policymakers will make use of your findings?
What I think would be neat is to raise awareness that counties are doing things differently, which means that the same behavior is treated very differently depending on where a person lives. It seems to me that if I lived in a county that was using death by distribution a lot, and in fact, Orange County, where I live, is one of those that uses it more, I would want to know that, especially if I were trying to do direct service with people who use drugs. So if I were working in a harm reduction field, like at the Public Health Department or through the North Carolina Harm Reduction Coalition, or any of the programs across the state trying to create bridges and connect people to resources and communities and help people who are struggling, I would want to be aware of this, to learn about the impact and share whatever information I had. And honestly, what I've gathered is that one reason there is so much charging in certain places compared to others is that there will be local people who may have lost someone they loved to a drug overdose, and they want to seek justice for that person. And this is what justice looks like to them. So what I'd really like to know is, for families that had someone die and had the person who shared the drug with that person be prosecuted, how was that for them? Did it really get them what they wanted? Did it feel like justice to them? And maybe it did, or maybe it didn't.
Dr. Easter and her co-authors have submitted their findings to a peer-reviewed academic journal and hope the work will be published this year. Stay tuned for more on their work!