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
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