The Impact of Extreme Risk Protective Orders on Firearm Fatalities

Am J Prev Med. 2025 May 9:107652. doi: 10.1016/j.amepre.2025.107652. Online ahead of print.

ABSTRACT

INTRODUCTION: Although a growing number of states have implemented Extreme Risk Protective Orders (ERPOs) to curb gun violence, existing studies on ERPOs have been limited in scope, focusing on a few states, and often lacking robust methodologies to identify their effects. In this work, we estimate the effect of ERPO codification on firearm fatalities (homicides and suicides). Further, we examine heterogeneity in fatalities across racial subpopulations and those who can petition for such restrictions (viz. law enforcement, family members, healthcare professionals).

METHODS: Using a difference in difference approach, we estimate changes in outcomes across nineteen treated states and the District of Columbia which implemented ERPOs, and thirty-one control states. The sample runs from 1998 to 2020, including 288,250 homicides and 450,956 suicides involving firearms. Data are drawn from National Center for Health Statistics (NCHS) death certificates.

RESULTS: Empowering health professional petitioners significantly reduces suicides overall, most prominently among White victims (-14.79% [95% CI, -19.18% to -10.24%], 7∼16 state yearly net effect). Including family members as petitioners significantly decreases homicides overall, and most prominently among Black victims to varying degrees in most models.

CONCLUSIONS: Results indicate significant differences in the efficacy of ERPO implementation on firearm-related homicides and suicides across petitioners and subpopulations. Our study underscores the benefits of diversified petitioners and their role in ending violence across different communities.

PMID:40349740 | DOI:10.1016/j.amepre.2025.107652