Temporarily removing firearms from people at risk of harm saves lives

An estimated one life was saved for every 17 times an extreme risk protection order removed guns from people who presented a risk of harming themselves or others, according to a Duke Health-led analysis of the laws in four states.

Extreme risk protection orders—known as ERPOs or “red flag laws”—are civil court orders that temporarily prevent people from accessing firearms after a judge determines that they pose an imminent risk of harming themselves or others. Twenty-one states and the District of Columbia have enacted ERPO laws, mostly in recent years.

A growing body of evidence shows that this legal tool can save lives, while also respecting the rights of gun owners. The current study, appearing in the Journal of the American Academy of Psychiatry and the Law, was the largest study to date.

“This analysis provides important information for making the case that ERPOs can save lives,” said lead author Jeffrey Swanson, Ph.D., professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. “These laws do not affect private gun ownership rights for anyone who is not dangerous and is law abiding, and they are broadly supported by people across the political spectrum.”

Swanson and colleagues analyzed risk orders issued to 4,583 individuals in California, Connecticut, Maryland and Washington, and used death records to identify who among those with ERPOs had died of suicide, and by what method.

The chances of surviving a suicide attempt vary widely depending on the method of intentional self-harm that is available and used. Firearms are far and away the most lethal, with a 90% fatality rate. By contrast, only about 10% of suicide attempts using most other common methods are fatal.

The researchers applied published fatality rates for different methods of self-harm to estimate the number of non-lethal suicide attempts that likely corresponded to the recorded number of suicide deaths by each method.

They used other data to estimate the probability that individuals who survived these attempts with other methods would have used a firearm instead—and died—but for the weapon’s removal by an ERPO.

Based on that analysis, the researchers estimated that ERPOs likely contributed to the prevention of approximately 269 suicides over an average observation period of two years per respondent, which translated to one life saved for every 17 ERPOs issued.

“Even if we reduce many of the things that motivate people to injurious behavior, we still live in a society where people have easy access to technology designed to kill efficiently,” Swanson said. “Addressing access to firearms for people who are at risk of harming themselves or others is an evidence-based approach that can save lives.”

Swanson said the research demonstrates a need for more states to adopt ERPOS and to increase their use in states that already have the laws, noting that the laws have wide public support: “Nobody wants dangerous people to have access to guns.”

In addition to Swanson, study authors include April M. Zeoli, Shannon Frattaroli, Marian Betz, Michele Easter, Reena Kapoor, Christopher Knoepke, Michael Norko, Veronica A. Pear, Ali Rowhani-Rahbar, Julia P. Schleimer, and Garen J. Wintemute.