Researchers led by Michele M. Easter of the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine, working with colleagues at the Wilson Center for Science and Justice at Duke Law, examined death by distribution prosecutions across all of North Carolina between 2013 and 2024. Their analysis, published in the American Journal of Criminal Justice, drew on court records spanning the state’s 42 prosecutorial districts and 100 counties. The goal was to map how often these charges were filed over time and to identify the district- and county-level characteristics associated with prosecution. The findings point to what the authors call geographic arbitrariness in the application of a law born from the overdose crisis.

The study documented 557 death by distribution court charges statewide over the study period. The trajectory was steep. Although North Carolina first passed a death by distribution statute in 2017, the vast majority of charges, 88 percent, were filed after 2020, when a new version of the legislation took effect. That expansion coincided with the worsening of the fentanyl era, during which both overdose deaths and DD-charging rose together across the state. Cases moved at varying speeds: an examination of case-level court data showed a mean of 155 days between the overdose offense date and the filing of charges, with a median of 121 days and a striking range from zero to 897 days.

A crucial technical detail of the statute shapes who can be swept into its net. Sixty percent of the charges were filed under the least serious form of death by distribution, a felony class that does not require proof of a drug sale, an intent to distribute, or any prior criminal history. In practice, this category could apply to virtually any instance of drug sharing that ends in a fatal overdose, including situations where two people used the same substance together and one did not survive. Because this broadest form dominated the caseload, most of the researchers’ statistical analysis focused on it, and its reach raises the stakes of understanding how charging decisions are actually made.

The core empirical question was whether prosecutions track the underlying public health crisis. They do not, at least not cleanly. Correlations between the number of overdose deaths in a district or county and the number of death by distribution charges were weak. If the law functioned as a direct, proportionate response to overdose mortality, one would expect jurisdictions with more deaths to file more charges. Instead, the pattern was scattered and uneven, with some places generating charges at rates far out of proportion to their overdose burden. One district, comprising Stanly and Montgomery counties, and nine individual counties, including Martin, Carteret, Stanly, Graham, Washington, Polk, Chatham, Northampton, and Pamlico, emerged as high outliers in charges per 1,000 overdose deaths.

To understand what did drive charging, the team built regression models relating death by distribution charging rates to district and county characteristics. The most consistent predictors were population size, racial composition, and poverty. Among the 42 prosecutorial districts, the relationship between racial composition and death by distribution cases was curvilinear and bell-shaped, meaning charges peaked in districts with intermediate racial compositions rather than rising linearly. Among the 100 counties, greater poverty was associated with fewer death by distribution charges after adjusting for population, a counterintuitive finding that complicates any simple narrative about who bears the brunt of these prosecutions.

The practical implication is stark: two people who engage in essentially identical conduct, sharing drugs with a friend who then dies, face radically different legal risks depending on which side of a county or district line they happen to live on. This mirrors a pattern documented in the capital punishment literature, where researchers have shown for decades that the decision to seek the death penalty varies enormously across counties within the same state, an earlier body of work that inspired the title of the North Carolina study. In the context of overdose, however, the stakes extend beyond sentencing disparities to the integrity of public health policy itself.

That is because a substantial body of research suggests death by distribution laws may actively undermine evidence-based responses to substance use disorder. Public health approaches to the overdose crisis depend on people who use drugs calling for help during an emergency, carrying naloxone, and being honest with medical providers and harm reduction workers about what they took. Studies of Good Samaritan overdose laws show that fear of legal consequences suppresses 911-calling behavior among overdose witnesses, and research with incarcerated people has described a deterrence paradox in which removing one supplier from a drug market simply creates a vacancy for the next. Prosecutors and legal scholars have also documented that these statutes often rest on mistaken assumptions about how illicit drug markets work, since many people charged never intended to sell anything and shared doses among equals.

The North Carolina study is careful to frame its findings as a starting point rather than a verdict. The authors note that their work invites conversations about potential alternatives for those who seek justice for people who die from overdose, ranging from restorative justice practices to public health-centered responses that treat overdose as a preventable medical outcome rather than a homicide. They also emphasize that crisis-driven legislation, passed in moments of acute grief and public alarm, often produces laws whose real-world application diverges sharply from their stated aims, a dynamic observed in other domains of American policy. The uneven geography of death by distribution charging documented here offers a statewide, data-driven illustration of that divergence.

What the study ultimately delivers is a map of legal exposure that no one designed and no one defends. A law intended to target predatory suppliers is, in its most commonly used form, reaching people whose culpability may amount to little more than shared drug use, and the likelihood of being charged at all depends on local prosecutorial culture, community demographics, and economic conditions. As more states adopt similar statutes amid the ongoing fentanyl crisis, the North Carolina data provide a template for the questions they should expect: not only whether these laws deter overdose deaths, but whether the decision to transform a tragedy into a homicide case can be justified when it is, in effect, decided by geography.

Subject of Research: Death by distribution prosecutions for fatal drug overdoses across North Carolina

Article Title: Geographic Arbitrariness? Examining Death by Distribution Prosecutions Statewide in North Carolina

Article References: Easter, M. M., Grunberg, R. L., Stenger, M., Bass-Patel, L., Swanson, J. W., & Lee, A. (2026). Geographic Arbitrariness? Examining Death by Distribution Prosecutions Statewide in North Carolina. American Journal of Criminal Justice. https://doi.org/10.1007/s12103-026-09935-x

Image Credits: AI Generated

DOI: 10.1007/s12103-026-09935-x

Keywords: death by distribution, drug-induced homicide, overdose, opioid crisis, fentanyl, prosecution, North Carolina, substance use disorder, geographic disparity, criminal justice, public health, harm reduction