Purpose To examine state-level opioid overdose mortality trends in the United States and assess their association with drug policy environments. Methods This ecological study analyzed opioid-related overdose death data from 2018 to 2023 for all U.S. states using CDC WONDER. Linear regression estimated state-level mortality trends. The five states with the steepest increases and five with the most stable or improving trends were identified. Drug policies for these ten states were reviewed using the Global Drug Policy Index and correlated with mortality trends. Results Opioid overdose deaths totaled 405,682 nationally, with the crude death rate peaking at 29.8 per 100,000 in 2022. Mortality was highest among males, adults aged 35–44, and Black or African American individuals. West Virginia, Alaska, Washington, Tennessee, and Oregon had the steepest increases, while New Jersey, Utah, New Hampshire, Maryland, and South Dakota showed the most stable or improving trends. Less punitive policy scores (r = 0.76, p = 0.011) and high proportionality of the criminal justice system (r = 0.41, p = 0.239) were correlated with rising trends in death rates, while harm reduction (r = −0.53, p = 0.112) and access to painkillers (r = −0.52, p = 0.118) showed negative correlations. Conclusions Opioid mortality increased nationally during the study period. Among the ten purposively selected states, higher policy scores for the Absence of Extreme Responses (i.e., less punitive) were associated with worsening mortality trends. Whereas higher policy scores for Harm Reduction and Access to Medicines were associated with more favorable mortality trends, although these associations were not statistically significant. This small, extreme-case study demonstrated the feasibility of conducting in-depth analyses of multiple drug policy domains and generated hypotheses for testing in a larger study including all U.S. states.
Anthropomorphic design is widely assumed to shape self-disclosure and emotional dependence by first cultivating felt empathy and trust, and the safety measures platforms deploy, such as labelling and disclosure of artificial origin, target those perceptions. Across a twelve-country survey, forty-seven interviews, and three experiments, this research tests that mediation model and identifies the route that carries the behavioural effect. A twelve-country survey (N = 1480) found empathy and trust negligibly related to disclosure and dependence at the trait level. Two experiments (N = 390 and N = 300) produced strong direct effects of an anthropomorphic agent, with the anthropomorphic agent roughly tripling the odds of behavioural disclosure (63% versus 35% under a matched neutral prompt), while the indirect effects through empathy and trust received no support. Study 5 (N = 300) measured competing mediators and provided the most defensible interim account of the mechanism: only perceived anonymity and reduced evaluation apprehension carried the effect on disclosure, locating the process in online disinhibition rather than felt relational warmth. Forty-seven interviews surfaced clinically salient disclosure, including suicidal ideation revealed to a chatbot and to no person. Because the consequences of anthropomorphic design travel through the lowered social risk of the medium, safeguards that recalibrate how users perceive an agent may leave disclosure and dependence largely untouched.
