According to an analysis of laws in four states led by Duke Health, an estimated one life was saved for every 17 times an extreme risk protection order was used to take away guns from people who posed a danger to themselves or others.

Extreme Risk Protection Orders – known as ERPOs or “red flag laws” – are civil orders that temporarily bar people from accessing firearms after a judge determines they pose an imminent danger to themselves or others. Twenty-one states and the District of Columbia have enacted ERPO laws, most of them in the last few years.

Mounting evidence shows that this legal tool can save lives while protecting the rights of gun owners. The current study, published in the Journal of the American Academy of Psychiatry and Lawwas the most comprehensive study to date.

“This analysis provides important information to prove that ERPOs can save lives,” said lead author Jeffrey Swanson, Ph.D., a professor in the department of psychiatry and behavioral sciences at Duke University School of Medicine. “These laws do not impinge on the right of private gun ownership for individuals who are not dangerous and obey the law, and they have support from people across the political spectrum.”

Swanson and his colleagues analyzed risk orders issued to 4,583 people in California, Connecticut, Maryland, and Washington, and used death records to determine who among those with ERPOs had died by suicide and how.

The chances of survival from a suicide attempt vary greatly depending on which method of intentional self-harm is available and used. Firearms are by far the most lethal means, with a fatality rate of 90%. In contrast, only about 10% of suicide attempts using most other common methods are fatal.

The researchers used published death rates for different methods of self-harm to estimate the number of nonfatal suicide attempts, which probably corresponded to the recorded number of suicide deaths by each method.

They used other data to estimate the likelihood that people who survived these attempts by other methods would have used a firearm instead—and died—if the gun had not been confiscated by an ERPO.

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

“Even if we reduce many of the things that motivate people to engage in violent behavior, we still live in a society where people have easy access to technologies designed for efficient killing,” Swanson said. “Easier access to firearms for people at risk of harming themselves or others is an evidence-based approach that can save lives.”

Swanson said the study shows that more states need to implement ERPOS and that their use should be expanded in states that already have such laws. He pointed out that the laws have broad public support: “Nobody wants dangerous people to have access to guns.”

In addition to Swanson, the 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.