Memorandum

To: Interested Stakeholders, Policymakers, and Public Health Officials

From: Dr. Joshua Barocas, Executive Director, Colorado Poverty and Health Initiative and Professor of Medicine and Epidemiology, CU Anschutz Medical Campus

Date: June 19, 2026

Subject: Projected Overdose Mortality Outcomes Under Colorado Ballot Initiative #85

This memorandum summarizes findings from a modeling analysis examining the potential impact of Ballot Initiative #85 – Penalties for Fentanyl Crimes, which will appear on Colorado’s November 2026 General Election ballot, on opioid overdose mortality.

Using the peer-reviewed simulation model developed by Savinkina et al. and published in the International Journal of Drug Policy, Volume 121, 2023, we compared a baseline scenario reflecting Colorado’s existing fentanyl possession laws to a policy scenario designed to approximate the effects of Ballot Initiative #85. The model incorporates Colorado-specific assumptions regarding fentanyl prevalence in the street drug supply, court diversion practices, treatment engagement, and access to Medication for Opioid Use Disorder (MOUD). It simulates how people charged with fentanyl possession move through the criminal legal system and treatment systems over time, estimating the effects of different possession laws on overdose deaths, incarceration, and state costs over a five-year period.

Results

The analysis projects that policies associated with Ballot Initiative #85 could result in:

• An estimated 41.3% increase in opioid overdose deaths over five years• Approximately 1,718 additional overdose deaths over 5 years

These findings are consistent with a growing body of public health research indicating that punitive approaches to substance use and substance use disorders increases overdose risk because they disrupt treatment access and continuity of care.

Background

Ballot Initiative #85 would substantially increase criminal penalties associated with fentanyl possession and distribution offenses. Supporters of the measure argue that increased penalties will reduce fentanyl use and overdose deaths. However, a growing body of public health literature has found that criminalization strategies can produce unintended consequences, including reduced treatment engagement and increased exposure to circumstances associated with elevated overdose risk.

Individuals with opioid use disorder face particularly high risks of overdose following disruptions in treatment, periods of abstinence, and transitions between community and correctional settings. Because Ballot Initiative #85 would alter how fentanyl possession cases are handled within the criminal legal system, understanding its potential impact on overdose mortality is an important public health consideration.

To evaluate these potential impacts, a Colorado-specific simulation model was used to compare projected outcomes under current law with those under a policy environment that approximates Ballot Initiative #85.

Methods

This analysis utilized the peer-reviewed systems model developed by Savinkina and colleagues and calibrated it using Colorado-specific data and assumptions. The model estimates opioid overdose mortality over a five-year period under varying policy conditions.

Baseline Assumptions

The model incorporated the following Colorado-specific assumptions that are based on existing data and/or expert experience:

• Estimated population with opioid use disorder: 139,867 individuals

• Proportion of the illicit drug supply containing fentanyl: 45%

• Community MOUD participation rate: 7%

• Proportion of justice-involved individuals who initiate or are linked to MOUD following incarceration: 13%

• Diversion participation for eligible first-time fentanyl possession offenses: 70%

• Colorado-specific treatment capacity data and assumptions regarding continuity of care for individuals with opioid use disorder

Ballot Initiative #85 Scenario Assumptions

The Ballot Initiative #85 scenario modeled the effects of the measure's increased criminal penalties alongside a relative reduction in the use of diversion programs due to limited capacity and increased demand.

Findings

Current Colorado Policy Scenario

Under current Colorado policy, the model projects approximately 4,164 opioid overdose deaths over a five-year period.

Ballot Initiative #85 Scenario

Under the Ballot Initiative #85 scenario, the model projects approximately 5,882 opioid overdose deaths over the same five-year period.

Projected Change

Compared against the current Colorado policy, the Ballot Initiative #85 scenario is associated with:

• An estimated increase of 1,718 opioid overdose deaths over five years.• A projected 41.3% increase in overdose mortality.

These findings suggest that the policy changes modeled under Ballot Initiative #85 may be associated with substantially higher overdose mortality than the current Colorado law.

Interpretation

The primary finding of this analysis is that the Ballot Initiative #85 scenario was associated with higher projected overdose mortality than the baseline policy scenario.

The mechanism driving this outcome appears to be the interaction between involvement in the criminal legal system and access to treatment. While criminal justice involvement may create opportunities for treatment engagement for some individuals, the current treatment infrastructure reaches only a portion of people with opioid use disorder.

Research has consistently shown that interruptions in treatment, reduced opioid tolerance, and barriers to continuity of care can increase overdose risk. Individuals who experience periods without treatment may face elevated vulnerability to overdose upon return to substance use.

The model suggests that reductions in diversion participation may lead to greater exposure to these risk factors without producing corresponding increases in treatment engagement sufficient to offset those risks.

These findings are consistent with a substantial body of literature documenting elevated overdose risk following criminal legal system involvement and the limited effectiveness of punitive drug policies in reducing overdose mortality.

Limitations

Several limitations should be considered when interpreting these findings.

First, simulation models estimate likely outcomes based on best available evidence and assumptions; they do not predict exact future events. The results of this analysis can help us understand the likely direction and scale of change in overdose deaths.

Second, the analysis relies on assumptions regarding diversion participation, fentanyl prevalence, treatment access, and treatment engagement. Changes in any of these variables could affect projected outcomes.

Third, future policy changes that substantially expand access to evidence-based treatment, including MOUD, could alter projected mortality outcomes.

Despite these limitations, the model used in this analysis was specifically designed to examine the relationship between fentanyl possession policies, treatment access, and overdose mortality and has undergone peer review. The direction of the findings is also consistent with a broader body of public health research examining overdose risk among people with opioid use disorder.

Conclusions

This analysis projects that a policy environment approximating Ballot Initiative #85 could be associated with approximately 5,882 opioid overdose deaths in Colorado over five years, compared with an estimated 4,164 overdose deaths under the current Colorado policy.

The model estimates an additional 1,718 overdose deaths, representing a projected 41.3% increase in overdose mortality.

While simulation models cannot predict future outcomes with certainty, these findings suggest that increasing criminal penalties without corresponding expansions in evidence-based treatment access will increase overdose deaths across Colorado communities.

Given the ongoing overdose crisis in Colorado, the projected increase in mortality warrants careful consideration of the public health implications of a policy like Ballot Initiative #85 that relies primarily on increased criminal penalties as a response to overdose mortality.

References

Alexandra Savinkina, Cole Jurecka, Gregg Gonsalves, Joshua A. Barocas. Mortality, incarceration and cost implications of fentanyl felonization laws: A modeling study, International Journal of Drug Policy, Volume 121, 2023

Colorado Department of Corrections. Medication for Opioid Use Disorder (MOUD) Program Report, 2023.

Colorado Department of Corrections Legislative Briefings and OUD Treatment Reports, 2024–2025.