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Journal ArticleDOI

Colorado’s first year of extreme risk protection orders

TL;DR: In the first year of the Extreme Risk Protection Order (ERPO) as discussed by the authors, 109 petitions were filed in Colorado, of which 61 were granted for a temporary ERPO and 49 for a full (year-long) ERPO.
Abstract: Background Extreme Risk Protection Orders (ERPOs) are a relatively new type of law that are being considered or implemented in many states in the United States. Colorado's law went into effect on January 1, 2020, after significant controversy and concern over potential misuse of the law to confiscate weapons; many (n = 37 of 64) counties declared themselves "2nd Amendment (2A) sanctuaries" and said they would not enforce the law. Here, reviewed the patterns of use of the law during its first year. Methods We obtained all court records for ERPO petitions filed between January 1 and December 31, 2020. Data elements were abstracted by trained staff using a standardized guide. We calculated the proportion of petitions that were approved or denied/dismissed, identified cases of obvious misuse, and examined patterns by 2A county status. Finding and results In 2020, 109 ERPO petitions were filed in Colorado; of these, 61 were granted for a temporary ERPO and 49 for a full (year-long) ERPO. Most petitions filed by law enforcement officers were granted (85%), compared to only 15% of petitions filed by family or household members. Of the 37 2A sanctuary counties, 24% had at least one petition filed, versus 48% of non-2A sanctuary counties. Across the 2A counties, there were 1.52 ERPOs filed per 100,000 population, compared to 2.05 ERPOs filed per 100,000 in non-2A counties. There were 4 cases of obvious law misuse; none of those petitions resulted in an ERPO or firearm confiscation. Conclusion State-level studies suggest ERPOs may prevent firearm injuries. Robust implementation, however, is critical for maximal effect. Understanding ERPO experiences and challenges can inform policy creation and enaction in other states, including identifying how best to address concerns and facilitate evaluation.

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TL;DR: GVROs were used most often by law enforcement officers to prevent firearm assault/homicide and post-GVRO firearm fatalities among respondents were rare, and future studies should investigate additional respondent outcomes and potential sources of heterogeneity.
Abstract: Background Gun violence restraining orders (GVROs), implemented in California in 2016, temporarily prohibit individuals at high risk of violence from purchasing or possessing firearms and ammunition. We sought to describe the circumstances giving rise to GVROs issued 2016–2018, provide details about the GVRO process and quantify mortality outcomes for individuals subject to these orders (‘respondents’). Methods For this cross-sectional description of GVRO respondents, 2016–2018, we abstracted case details from court files and used LexisNexis to link respondents to mortality data through August 2020. Results We abstracted information for 201 respondents with accessible court records. Respondents were mostly white (61.2%) and men (93.5%). Fifty-four per cent of cases involved potential harm to others alone, 15.3% involved potential harm to self alone and 25.2% involved both. Mass shooting threats occurred in 28.7% of cases. Ninety-six and one half per cent of petitioners were law enforcement officers and one-in-three cases resulted in arrest on order service. One-year orders after a hearing (following 21-day emergency/temporary orders) were issued in 53.5% of cases. Most (84.2%) respondents owned at least one firearm, and firearms were removed in 55.9% of cases. Of the 379 respondents matched by LexisNexis, 7 (1.8%) died after the GVRO was issued: one from a self-inflicted firearm injury that was itself the reason for the GVRO and the others from causes unrelated to violence. Conclusions GVROs were used most often by law enforcement officers to prevent firearm assault/homicide and post-GVRO firearm fatalities among respondents were rare. Future studies should investigate additional respondent outcomes and potential sources of heterogeneity.

6 citations

Journal ArticleDOI
TL;DR: In this paper , the authors present the rationale behind four types of laws that restrict access to firearms for those who are deemed to be a high risk for future gun violence and two types of firearm purchase prohibitions.
Abstract: We present the rationale behind four types of laws that restrict access to firearms for those who are deemed to be a high risk for future gun violence and two types of laws that implement firearm purchase prohibitions. We also present evidence on the effectiveness of these laws. Broadly, these are laws that restrict access for domestic violence abusers, individuals convicted of misdemeanor violence, and individuals at high risk of violence against themselves or others. We briefly discuss relinquishment of firearms by those who are newly restricted, but we focus mainly on how purchase restrictions are implemented by the federal government and across states. Extant research shows that well-implemented firearm policy that is based on evidence-based risk factors can be effective in reducing firearm injury.

2 citations

Journal ArticleDOI
TL;DR: Extreme risk protection orders (ERPOs) are a legal mechanism that enables law enforcement to temporarily remove firearms from, and prevent firearm purchase by, an individual who presents a significant danger to self or others, as determined by a court of law as discussed by the authors .
Abstract: Extreme risk protection orders (ERPOs) represent a potential mechanism to facilitate firearm-related lethal means safety. ERPOs are a legal mechanism that enables law enforcement to temporarily remove firearms from, and prevent firearm purchase by, an individual who presents a significant danger to self or others, as determined by a court of law. While few jurisdictions currently allow mental health professionals to initiate ERPO petitions, it nonetheless seems important that clinicians be familiar with ERPOs, as clinicians may still serve an important role in disseminating information and facilitating judicious petitions. However, ERPO laws remain quite new, and the implications for mental health professionals when participating (directly or indirectly) in ERPOs remain unclear. This column introduces readers to ERPOs and offers resources to learn more about how ERPOs work across various jurisdictions.
References
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Journal ArticleDOI
TL;DR: Assessment of WISQARS found areas for improvement included building more capacity for data visualisations and for users to export both data and graphics, allowing for full mobile responsiveness when accessing, and developing better support information and guidance on use.
Abstract: Background WISQARS is an interactive, web-based data query system (WBDQS) that is accessible from the internet. It includes modules for fatal and non-fatal injuries, a separate module on violent deaths, and injury costs and maps. Data come from a variety of trusted sources, including national health surveys and health data repositories. CDC created WISQARS in 1999 to meet the data needs of injury practitioners in the United States. Since that time, the audience has expanded to include researchers, policy makers, media, and the general public. Objective The purpose of this evaluation was to assess the focus, quality, usefulness, impact, and outcomes of WISQARS; and to identify gaps and areas for improvement. Data were collected through peer-reviewed and grey literature searches, google searches, an environmental scan of internal and external WBDQS, and a series of stakeholder interviews. Results WISQARS is used as a data source by NGOs, academic institutions, other U.S. federal agencies, and social media websites. Stakeholders most frequently used the fatal and non-fatal modules. The most frequently accessed data were on suicides, poisonings, homicides, motor vehicle crashes, and falls. WISQARS is most often used to respond to data requests, educate decision makers, conduct basic analyses, and teach and plan. Areas for improvement included building more capacity for data visualisations and for users to export both data and graphics, allowing for full mobile responsiveness when accessing, expanding by incrementally including additional data, and developing better support information and guidance on use. Conclusions While WISQARS has been largely a success in expanding access to U.S. injury and violence surveillance data, there are several opportunities to enhance the functionality of the system for the end user. CDC is planning to use innovations in data science to enhance WISQARS’s capacity.

802 citations

Journal ArticleDOI
TL;DR: To examine the prevalence and correlates of violence among schizophrenia patients living in the community by developing multivariable statistical models to assess the net effects of psychotic symptoms and other risk factors for minor and serious violence, a large number of patients diagnosed as having schizophrenia were enrolled.
Abstract: Context Violent behavior is uncommon, yet problematic, among schizophrenia patients. The complex effects of clinical, interpersonal, and social-environmental risk factors for violence in this population are poorly understood. Objective To examine the prevalence and correlates of violence among schizophrenia patients living in the community by developing multivariable statistical models to assess the net effects of psychotic symptoms and other risk factors for minor and serious violence. Design A total of 1410 schizophrenia patients were clinically assessed and interviewed about violent behavior in the past 6 months. Data comprise baseline assessments of patients enrolled in the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness. Setting and Patients Adult patients diagnosed as having schizophrenia were enrolled from 56 sites in the United States, including academic medical centers and community providers. Main Outcome Measures Violence was classified at 2 severity levels: minor violence, corresponding to simple assault without injury or weapon use; and serious violence, corresponding to assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault. A composite measure of any violence was also analyzed. Results The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior. Distinct, but overlapping, sets of risk factors were associated with minor and serious violence. “Positive” psychotic symptoms, such as persecutory ideation, increased the risk of minor and serious violence, while “negative” psychotic symptoms, such as social withdrawal, lowered the risk of serious violence. Minor violence was associated with co-occurring substance abuse and interpersonal and social factors. Serious violence was associated with psychotic and depressive symptoms, childhood conduct problems, and victimization. Conclusions Particular clusters of symptoms may increase or decrease violence risk in schizophrenia patients. Violence risk assessment and management in community-based treatment should focus on combinations of clinical and nonclinical risk factors.

715 citations

Journal ArticleDOI
TL;DR: The rate of opioid analgesic overdose is proportional to the number of opioid prescriptions and the dose prescribed and this review considers the epidemiology, mechanisms, and management of opioids overdose.
Abstract: The rate of opioid analgesic overdose is proportional to the number of opioid prescriptions and the dose prescribed. This review considers the epidemiology, mechanisms, and management of opioid analgesic overdose.

425 citations

Journal ArticleDOI
TL;DR: The NESARC data are consistent with the consensus view on mental disorder and violence: there is a statistically significant, yet modest relationship between SMI (within 12 months) and violence, and a stronger relationship betweenSMI with substance use disorder andviolence.
Abstract: A general consensus exists that severe mental illness (SMI) increases violence risk. However, a recent report claimed that SMI “alone was not statistically related to future violence in bivariate or multivariate analyses.” We reanalyze the data used to make this claim with a focus on causal relationships between SMI and violence, rather than the statistical prediction of violence. Data are from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a two-wave study (N = 34,653: Wave 1: 2001–2003; Wave 2: 2004–2005). Indicators of mental disorder in the year prior to Wave 1 were used to examine violence between Waves 1 and 2. Those with SMI, irrespective of substance abuse status, were significantly more likely to be violent than those with no mental or substance use disorders. This finding held in both bivariate and multivariable models. Those with comorbid mental and substance use disorders had the highest risk of violence. Historical and current conditions were also associated with violence, including childhood abuse and neglect, household antisocial behavior, binge drinking and stressful life events. These results, in contrast to a recently published report, show that the NESARC data are consistent with the consensus view on mental disorder and violence: there is a statistically significant, yet modest relationship between SMI (within 12 months) and violence, and a stronger relationship between SMI with substance use disorder and violence. These results also highlight the importance of premorbid conditions, and other contemporaneous clinical factors, in violent behavior.

289 citations