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Does Traditional Drug Enforcement Make the Opioid Crisis Worse?

Five years after his curiosity was piqued when Indianapolis Emergency Medical Services workers told him that police drug seizures seemed to spark a run of opioid overdoses, RTI International researcher Brad Ray led a study that suggests traditional drug enforcement tactics could be making the drug-overdose crisis worse.

The new study in the American Journal of Public Health, funded by the Centers for Disease Control and Prevention, used data from about 1,800 incidents in Marion County, Ind., in 2020 and 2021 to compare police drug seizures with changes in overdoses in the same geographic area.

The data showed police drug seizures were "significantly associated with" clusters of overdoses — fatal overdoses, in particular, were two times higher than expected within one week and 500 meters of drug seizure locations. The largest increase seen was in EMS workers' administration of naloxone doses.

Although the research team cautioned that its findings don't prove causation, Ray said in a Twitter thread that the study suggests that disruptions in trusted drug supplies can lead people to supplies of unknown potency. And that, he said, means "we need to consider new interventions that mitigate harms while also considering whether current policies and practices exacerbate them."

Another researcher on the team, veteran New York police officer and Burlington, Vt., police chief Brandon del Pozo, said on Twitter that a replacement drug supply "will most certainly have fentanyl in it" of an unknown strength. "When a user's opioid supply is interrupted, their tolerance starts decreasing by some imprecise, unknown amount," del Pozo wrote. "Withdrawal sets in and risk aversion decreases."

The findings indicate, del Pozo wrote, that "unknown tolerance, unknown potency, reduced risk aversion, and no margin of error in safely dosing fentanyl can all lead to the increased fatal overdose observed in our study."

Del Pozo, now an assistant professor at Brown University, thanked the Indianapolis Metro Police Department, "an innovative agency of thoughtful leaders open to scientific inquiry and sharing data," for making the study possible.

Ray said RTI, a non-profit research firm, is working on replicating the study in other large U.S. cities. RTI summarized the study in this announcement.


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