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HomeMy WebLinkAbout2016-08-08 16-290 Council Documents (24) Addiction ,Y3 RESEARCH REPORT doi:10.1111/j.1360-0443.2012.03872.x • Use of a `microecological technique' to study crime incidents around methadone maintenance treatment centers Susan J. Boyd', Li Juan Fang', Deborah R. Medoff, Lisa B. Dixon' & David A. Gorelick' Department of Psychiatry,University of Maryland School of Medicine,Baltimore,MD,USA,'Department of Psychiatry,Division of Services Research,University of Maryland School of Medicine,Baltimore,MD,USA2 and Intramural Research Program/National Institute on Drug Abuse/National Institutes of Health,Baltimore, MD,USA' ABSTRACT Aims Concern about crime is a significant barrier to the establishment of methadone treatment centers (MTCs). Methadone maintenance reduces crime among those treated,but the relationship between MTCs and neighborhood crime is unknown.We evaluated crime around MTCs.Setting Baltimore City,MD,USA.Participants We evaluated crime around 13 MTCs and three types of control locations: 13 convenience stores(stores), 13 residential points and 10 general medical hospitals.Measures We collected reports of Part 1 crimes from 1 January 1999 to 31 December 2001 from the Baltimore City Police Department.Design Crimes and residential point locations were mapped elec- tronically by street address(geocoded),and MTCs,hospitals and stores were mapped by visiting the sites with a global positioning satellite(GPS)Iocator.Concentric circular'buffers'were drawn at 25-m intervals up to 300 m around each site.We used Poisson regression to assess the relationship between crime counts(incidents per unit area)and distance from the site.Findings There was no significant geographic relationship between crime counts and MTCs or hospitals. A significant negative relationship (parameter estimate —0.3127, P<0.04) existed around stores in the daytime (7 am-7 pm),indicating higher crime counts closer to the stores.We found a significant positive relationship around residential points during daytime(0.5180,P<0.0001)and at night(0.3303,P<0.0001),indicating higher crime counts further away.Conclusions Methadone treatment centers,in contrast to convenience stores,are not associated geographically with crime. Keywords Crime,geocoding,methadone maintenance,neighborhood,spatial analysis. Correspondence to:Susan J.Boyd,Baltimore VAMC,Department of Psychiatry,10 N.Greene St.,Baltimore,MD 21201,USA.E-mail:susan.boyd@va.gov Submitted 27 July 2011;initial review completed 15 September 2011;final version accepted 27 February 2012 INTRODUCTION largely to concerns about crime [5,6]. This resistance exists despite extensive research over several decades, The aim of this study is to determine whether there is a showing that methadone maintenance treatment geographic relationship between methadone treatment decreases crime among treated patients.For example, a centers (MTCs) and neighborhood crime. Methadone study of 1075 heroin users found that methadone main- maintenance is well established as an effective treatment tenance plus psychosocial treatment decreased crime, for opiate dependence [1-3]. Opioid dependence is a resulting in decreased societal costs[7]. global public health problem, with an estimated 24-32 Community concerns about MTCs causing crime million opioid users(12-14 million heroin users)world- reflect a difference between'clinical'and'ecological'per- wide in 2009,including 3.1-3.5 million users in Europe spectives. While the clinical perspective has established [4]. Nevertheless, access to treatment is limited in that successfully treated patients commit fewer crimes many communities that oppose the establishment of new [8],there is no empirical evidence on the ecological rela- methadone maintenance treatment centers(MTCs),due tionship between MTCs and neighborhood crime.Three Published 2012.This article is a U.S.Government work and is in the public domain in the USA. Addiction,107,1632-1638 Crime and methadone treatment centers 1633 possible relationships could exist, and plausible theories Table 1 Characteristics of 13'Baltimore City,Maryland metha- • support each relationship. MTCs could decrease neigh- done maintenance treatment centers (MTCs) operating 1 borhood crime by treating opiate users who live nearby, January 1999 to 31 December 2001. thereby decreasing their risk of criminal behavior.MTCs Min Max Mode could increase crime if they attract untreated or partially treated users into the neighborhood, thereby increasing Opening time 5:30 am 11 am 7 am the local density of people likely to commit crimes [9]. Closing time 4 pm 7:30 pm 6 pm Finally, MTCs could have no crime impact if neighbor Min Max Mean Median hood crime relates largely to other factors. This study addresses the debate by evaluating relevant Daily patient census 55 600 298 300 empirical data with a technique that has not been applied previously to this issue. Previous studies of the geo- 'Includes combined data from three MTCs whose entrances were within graphic (spatial) relationship between locations of sub 25 m of another MTC(see text). stance availability(e.g.alcohol outlets,location of illegal drug possession and sales)and crime have used relation- ships between locations and crime rates averaged over opioid detoxification or maintenance therapy,in addition to methadone. large areas,typically postal codes or census tracts[9-11]. To help assess the significance of any relationship This study is the first of which we are aware to use a between MTCs and crime, we evaluated crime around more fine-grained'microecological'approach.Instead of three types of control sites in Baltimore City,MD.MTCs studying a population of patients or a large geographic might have more crime than adjacent locations because area where the MTCs are located, we evaluated crime of having higher foot traffic.High foot-traffic areas(areas rates in terms of increasing spatial distance within indi- with higher density of people)may have more crime than vidual MTC neighborhoods. low foot-traffic areas because offenders are more likely to The study was conducted in Baltimore, MD, USA, meet victims/targets in such areas [17]. Therefore, we an urban environment with a high rate of heroin use [12,13]and high crime rate[14].The city had 16 metha selected two'high foot-traffic'sites(general hospitals and convenience stores) and one 'low foot-traffic' site (resi- • done treatment centers (MTCs) in operation during the dential points)as controls.General medical hospitals(10 study period.A comparison of crime before and after the in operation in Baltimore during the study period)were establishment of MTCs was not possible, because most of the MTCs in Baltimore had been in operation before chosen because they, like MTCs, provide medical care. the advent of geocodable electronic crime data. 'Convenience stores' were those defined as such on the Switchboard.com [18] website. Residential points were defined as addresses in the middle of a block on a small METHODS secondary street within a geographic area identified as 'residential'by local zoning maps. Details of the 'microecologic technique' have been pub- lished previously [15]. In brief, we obtained a database Thirteen convenience stores and 13 residential sites listing all Federal Bureau of Investigation(FBI)Uniform were matched to the 13 MTCs based on 20 relevant census and crime variables (Table 2), which previous Crime Report 'Part 1' crimes [homicide, sexual assault, factor analytical research has shown can identify neigh- robbery,aggravated assault,burglary,larceny(including borhoods with high rates of violent crime [19]. These theft from a motor vehicle),auto theft and arson][16]in variables were entered into a factor analysis by Baltimore Baltimore City,MD,from 1 January 1999 to 31 December 2001 from the Baltimore City Police Department. We City Census Block Group (CBG); the analysis was pre- identified 16 MTCs operating in Baltimore during this defined to generate a single factor score. Control sites study period.One was excluded because it was located on were chosen for each clinic so that the factor scores the sixth floor of a general medical hospital, making it of their CBGs were closest to the factor score of their matched clinic. Hospitals could not be matched to the impossible to differentiate its crimes from those associated MTCs due to the limited number of hospitals(10)avail- with the hospital. Three of the remaining MTCs were able for matching. analyzed as one clinic, because their front entrances were within 25 m of each other,making it impossible to Data and geocoding analyze their crime data separately. Thus, we included data from 13 MTC's whose characteristics we obtained by Crime locations and residential control sites were mapped • telephone survey (Table 1). Of these, eight were on the electronically by'geocoding' their street addresses using campus of or near a hospital,but not in the same building the ArcGIS 9 computer program [20]. Geocoding is a as the hospital. Four MTCs offered buprenorphine for computerized process in which a street address is con- Published 2012.This article is a U.S.Government work and is in the public domain in the USA. Addiction,107,1632-1638 1634 Susan J. Boyd et al. • Table 2 Variables used in the factor analysis for matching Statistical analysis census block groups of methadone maintenance treatment centers(MTCs)and control study sites. Poisson regression analyses were used to evaluate the relationship between crime counts and distance from a Census variables site. First, a generalized additive model (GAM) with a %Staying at the same house for more than 5 years Population per square mile spline term was used to fit a line to scatter-plots to visu- Household size alize the data. The GAM graphs indicated that most %Female-headed households of the variation in crime incidents was within the first %People with no high school diploma 100 m(first four buffers) of the sites(data not shown). Per capita income Thus, further data analysis included only crime inci- Median household income dents within 100 m of the study sites.Further analyses Percent with income below poverty level used a Poisson distribution and generalized linear model Service workers to analyze crime counts around the study sites,generat- %People unemployed %Households with public assistance income ing a parameter estimate (13) through a least-squares %Households with no worker analysis. A significant positive (3 ('positive crime slope') %Non-white indicates a higher crime rate with increasing distance 'Racial heterogeneity'(count of different races reported) from the study site,while a significant negative[3('nega- %Vacant houses tive crime slope')indicates a higher crime rate closer to %Households renting home the study site. All analyses were performed with SAS Median gross rent version 9.1 [24]. Median value of owner-occupied home Crime variables 'Within-group'comparisons to evaluate the relation- Total crimes in 2000 ship between crime counts and distance from the site Total drug-related crimes (crime slopes)were performed separately for MTCs,con- venience stores,hospitals and residential points.Because crimes can occur at night, when MTCs are closed, we verted into a map location(latitude and longitude) [211 controlled for time of day by analyzing separately crimes • The locations of MTCs,convenience stores and hospitals occurring during the day (7 a.m.-7 p.m.), the hours were determined by visiting the sites and reading the lati- when most MTCs are open (Table 1), and at night (7 tude and longitude on a global positioning satellite(GPS) p.m.-7 a.m.). locator.Site visits were necessary in these cases,because street addresses of non-residential sites are sometimes not precise enough to generate an accurate latitude and RESULTS longitude. For example, convenience stores are some- There was no significant change in crime counts with times located in large parking lots or malls, along with increasing distance from MTCs or hospitals (Fig. 1), as other stores. In order to maintain the privacy of people indicated by non-significant values for parameter esti- living at the residential sites,the locations of the residen- mates of crime slopes(Table 3).In contrast,there was a tial sites were found by geocoding,rather than by visiting significant decrease in crime counts with increasing the site. distance from convenience stores during both daytime and night-time (Fig. 1, Table 3, daytime parameter 'Buffering'sites and counting crimes estimate—0.3127, P<0.04, night time parameter esti- We used a 'buffer' methodology to determine the geo mate —0.3235, P<0.0623). Around residential sites, graphic relationship between study sites and neigh there was a significant increase in crime counts, with borhood crime. Concentric circular, non-overlapping, increasing distance from the site during both daytime doughnut-shaped buffers were defined at 25-m intervals (0.5180, P<0.0001) and night-time (0.3303, for up to 300-m radius around each study site. Crimes P<0.0001). were counted within each buffer. In order to compare crime quantitatively across buffers of increasing size,the DISCUSSION number of crimes was corrected for the area of each buffer to generate crime counts per unit area ('crime This study found no significant change in crime counts counts').To avoid crime counts<1, the 'unit area' was with increasing distance(up to 100 m)from MTCs,sug- • defined as 1962.5 m2 [the size of the smallest (25-m) gesting that MTCs are not a geographic focus for crime.In buffer]. Similar buffer methodologies have been used to contrast,there was a significant decline in crime counts study crime around housing projects[22]and supportive with increasing distance from convenience stores and a housing[23]. significant increase in crime counts with increasing Published 2012.This article is a U.S.Government work and is in the public domain in the USA. Addiction,107.1632-1638 Crime and methadone treatment centers 1635 a •Day (7 AM to 7 PM) 3- i\ • 1-Methadone clinics 2-Hospitals \ '-•' 3-Convenience stores \ . .,``` •-•-• 4-Residential points n • \ - / -,-` \ --- �"` \x(r" / • \ o---- f' --d -- __--_ -t a x- • 0- 25 50 75 100 Buffer Distance (in meters) b Night(7 PM to 7 AM) 4 `"''• 1-Methadone clinics 2-Hospitals +-",. 3-Convenience stores r•-• 4-Residential points +\ • 3 \ \\ '— f \ - iJ�` I ___,E__--- --^" '—--—I '."�,—__ \ �c _-- -- - -fir x"' 0 , I 1 25 50 75 100 Buffer Distance (in meters) Figure I Crime rates around methadone maintenance treatment clinics,general medical hospitals,convenience stores and residential points in Baltimore City,MD(1999-2001).Crimes were all Federal Bureau of investigation (FBI) Part 1 crimes[homicide,sexual assault,robbery, aggravated assault,burglary,larceny(including theft from a motor vehicle),auto theft,and arson]reported in Baltimore City,MD between I January 1999 and 31 December 2001.Crime rate—crimes per'unit area'(1962 m2,the area of a 25-m circle/buffer).Buffer distance—radius of circular/doughnut-shaped areas defined around study sites.Study sites were 13 methadone maintenance treatment centers(MTCs), 10 general medical hospitals, 13 convenience stores and 13 residential points (residential addresses in the middle of the block on secondary streets).Convenience stores were matched to the MTCs by neighborhood characteristics(see text for details).Mapping of locations was based on street address for crime locations and residential sites and global positioning satellite(GPS)for other sites.(a)Crimes between 7 a.m.and 7 p.m.,when MTCs are open.(b) Crimes between 7 p.m.and 7 a.m.,when MTCs are closed • Published 2012.This article is a U.S.Government work and is in the public domain in the USA. Addiction,107,1632-1638 1636 Susan J. Boyd et al. Table 3 Poisson regression analysis of the relationship between crime counts'and distance(<--100 m)from study site. • Time of Parameter Standard Lower confidence Upper confidence Type of site day estimateb error limit limit Z P value MTC`[13] Dayd -0.0938 0.2243 -0.5334 0.3457 -0.42 0.6757 Night' -0.1614 0.2167 -0.5862 0.2634 -0.74 0.4564 Convenience Day -0.3127 0.1553 -0.6171 -0.0083 -2.01 0.0441 Store[13] Night -0.3235 0.1735 -0.6635 0.0166 -1.86 0.0623 Residential Day 0.3303 0.0511 0.2302 0.4304 6.47 <.0001 Site[13] Night 0.518 0.0947 0.3325 0.7035 5.47 <.0001 General medical Day 0.086 0.1353 -0.1792 0.3511 0.64 0.5251 hospital[10] Night -0.056 0.1533 -0.3564 0.2443 -0.37 0.7146 'Crime count:number of crime incidents per area in each concentric ring at 25-m intervals around the site."Parameter estimate:estimated'crime slope' relating crime counts with distance from study site.Positive parameter estimate indicates increasing crime counts with increasing distance from the site. Negative parameter estimate indicates decreasing crime counts with increasing distance from the site.cMTC:methadone maintenance treatment center. 'Day:7 a.m.-7 p.m.'Night:7 p.m.-7 a.m.Italics indicate significant results. distance from the residential sites, indicating that the intervals.For example, although methadone clinics and microecological technique is capable of detecting places residential points have different crime slopes (different that are or are not geographic foci of crime.The observed sign for the parameter estimate), there is no significant crime pattern around convenience stores (high foot- interaction term between the two groups when they are traffic areas)and around residential sites(low foot-traffic compared in a between-groups comparison. Secondly, areas in the middle of small residential blocks)is consis- this study has uncertain external validity because it tent with the previously shown positive correlation involved a relatively small number [15] of MTCs in a between crime and increased density of people at a site single city.However,there is no obvious manner in which • [17].Overall,the pattern of findings supports the validity Baltimore City MTCs differ from those in other areas of and sensitivity of our microecological technique, and the United States or abroad,nor is there any reason that strengthens confidence in our primary finding of no the neighborhood factors influencing crime in Baltimore significant increase in crime counts closer to MTCs. should differ from those elsewhere. Indeed, Baltimore An estimated 282 000 Americans were dependent on may be an'ideal' setting for this type of study, given its or abusing heroin and another 1.72 million were depen- high rate of heroin use (Baltimore has been called the dent on or abusing prescription pain relievers in 2008 'heroin capital' of the United States [12,13]), urban [25]. In contrast, only about 265 000 patients were environment and high crime rate[14]. receiving opiate agonist treatment in 1108 US treatment The stigma against methadone maintenance treat- facilities [26]. The European Union had more than 1 ment,including concerns about crime,exists throughout million regular opioid users in 2006, but only 25 000 the world[28-31], regardless of whether methadone is patients receiving methadone maintenance treatment dispensed in centralized methadone treatment centers [27].Thus,there is a public health need for more MTCs to or by prescription through community pharmacies. For treat the large numbers of people addicted to opiates.Our example,a survey of pharmacists in England found that finding that MTCs are not associated with increases in many expressed concern about shoplifting and aggres- neighborhood crime addresses a major impediment to the sion if they were to begin to dispense methadone [32]. establishment of new clinics,and should lead to greater Residents both in the United Kingdom and Canada voice availability of methadone maintenance treatment for the fears that methadone treatment centers may increase many people who need it. crime, resulting in difficulty opening or keeping open This study has several strengths,including the use of methadone clinics [33-35]. This study provides strong a microecological technique that evaluates geographic evidence against a major reason for the social stigma con- neighborhoods rather than patient populations, use of cerning methadone maintenance, i.e. concerns about control sites matched to the MTCs to minimize confound- crime.A major issue in the NIMBY('not in my back yard') ing by degree of foot traffic and other neighborhood phenomenon for MTCs is the need for patients to come in characteristics known to influence crime rates, and the daily for dosing.Buprenorphine,an opioid partial agonist inclusion of data from all but one of the MTCs operating now used in many countries for opioid substitution,can in Baltimore City during the study period. be prescribed by PhYsicians and dispensed for home This study has several limitations.First,the data show administration.Because there is no need for patients to substantial variability, as reflected in large confidence come to a specialized clinic for regular dosing,the hope is Published 2012.This article is a U.S.Government work and is in the public domain in the USA. Addiction,107,1632-1638 Crime and methadone treatment centers 1637 that buprenorphine treatment will be less stigmatized tration and the Intramural Research Program of the • and better accepted than methadone treatment. National Institutes of Health/National Institute on Finally,a key conceptual issue for any study involving Drug Abuse. crime is how to quantify crime.Three major parameters have been used to measure crime in social science studies, each with its own advantages and disadvantages:crime References incidents (used in this study), arrests and 911 calls. 1. Mattick R.P.,Breen C.,Kimber J.,Davoli M.Methadone main- Crime incidents, being generated from complaints of tenance therapy versus no opioid replacement therapy for crime,are not subject to policy changes in police enforce- opioid dependence.2009.Available at:http://onlinelibrary. wiley.com/o/cochrane/clsysrev/articles/CD002209/frame. ment,unlike arrest data.However,incident data have the html (accessed 21 October 2010) (archived by disadvantage of not recording'victimless'crimes,such as WebCite®at http://www.webcitation.org/5tefnHj1W). many drug crimes. Databases of 911 calls have the dis- 2. Mattick R.P.,Kimber J.,Breen C.,Davoli M.Buprenorphine advantage of containing a large number of 'unfounded' maintenance versus placebo or methadone mainten- events;that is,when the police arrive at the scene of the once for opioid dependence. 2008. Available at: http:// call,there is no evidence of the reported crime.However, onlinelibrarywiley.com/o/cochrane/clsysrev/articles/ CD002207/frame.html (accessed 21 October 2010) 911 databases may be a more sensitive measure of (archived by WebCite® at http://www.webcitation.org/ community concerns about crime. 5teeni4TE). Overall,our data show that MTCs are not a geographic 3. World Health Organization.Guidelines for the psychosocially focus of crime, thus providing both strong evidence to assisted pharmacological treatment of opioid dependence.World alleviate neighborhood concerns about the establishment Health Organization 2009.Available at:http://whqlibdoc. who.int/publications/2009/9 789241547543_eng.pdf and operation of MTCs and quantitative information to (accessed 18 January 2012) (archived by WebCitet5 at combat the stigma of methadone substitution treatment. http://www.webcitation.org/64mSjzTEy). As more MTCs open and more geocodable crime data 4. 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