Abstract
We conducted a systematic review that examined the link between individual drug categories and violent outcomes. We searched for primary case-control and cohort investigations that reported risk of violence against others among individuals diagnosed with drug use disorders using validated clinical criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We identified 18 studies published during 1990–2019, reporting data from 591,411 individuals with drug use disorders. We reported odds ratios of the violence risk in different categories of drug use disorders compared with those without. We found odds ratios ranging from 0.8 to 25.0 for most individual drug categories, with generally higher odds ratios among individuals with polydrug use disorders. In addition, we explored sources of between-study heterogeneity by subgroup and meta-regression analyses. Cohort investigations reported a lower risk of violence than case-control reports (odds ratio = 2.7 (95% confidence interval (CI): 2.1, 3.5) vs. 6.6 (95% CI: 5.1, 8.6)), and associations were stronger when the outcome was any violence rather than intimate partner violence (odds ratio = 5.7 (95% CI: 3.8, 8.6) vs. 1.7 (95% CI: 1.4, 2.1)), which was consistent with results from the meta-regression. Overall, these findings highlight the potential impact of preventing and treating drug use disorders on reducing violence risk and associated morbidities.
Highlights
Drug misuse is a global public health concern [1, 2]
The prevalence of drug use disorder in prison ranges from 10% to 61% in men and 30% to 69% in women [10], which is substantially elevated compared with the prevalence, ranging from 0.6% to 4.0% in men and 0.3% to 2.9% in women, in the general population [11]
We identified 18 eligible studies that included 591,411 individuals with drug use disorders
Summary
Drug misuse is a global public health concern [1, 2]. Worldwide, around 70 million individuals were diagnosed with a drug use disorder [1]. When compared with the general population, odds ratios of violence in cannabis use disorder have ranged from 1 to 7 [13,14,15,16,17], and in cocaine, they have varied from 2 to 11 [18,19,20,21]. This might be due to different methodologies adopted and specific outcomes used in different studies. This is important to clarify further in that more precise estimates would allow for risk stratification, better treatment allocation (especially if liaison with criminal justice agencies is required), and more
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