Do drug busts lead to more overdose deaths?

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Manisha Krishnan Even in places with the most progressive drug policies, selling drugs remains illegal. And having police go after drug dealers is usually a key component of any strategy to address the overdose crisis. It’s also a cornerstone of the war on drugs, a war North America has been waging for over 50 years. But what if we’ve been doing things all wrong? More than a million Canadians and Americans have died of an overdose in the last 20 years and those numbers continue to skyrocket. Because fentanyl the opioid driving most of the deaths is highly potent. It’s easier to smuggle, making police drug busts feel like a drop in the bucket. But are they actually worsening the epidemic? A study that was recently published in the American Journal of Public Health suggests so the study looked at two years worth of drug busts in Indianapolis and found that when police seized drugs, overdoses in the surrounding communities spike. While harm reduction activists have claimed this was true for a long time. This is the first empirical data making that late. What does or should this mean for drug policy going forward? My name is Manisha Krishnan and I’m a senior reporter at VICE News. And I’m sitting in Brooklyn under subway line, so don’t mind the noise. I’m filling in for Jordan Heath Rawlings. This is The Big Story. Grant Victor is an assistant professor at Rutgers University who researches harm reduction and drug policy. He co authored the study. Hi Grant.

Grant Victor Hello

Manisha Krishnan Thanks for being here.

Grant Victor Thanks for having me.

Manisha Krishnan So why did you decide to study this?

Grant Victor There have been a couple of studies that came out, that kind of piqued our interest around a similar phenomenon where they were looking at drug seizure data, using it as kind of a surveillance tool to see what drugs were in the drug market in a certain period of time. And some of those studies also looked at associations with with overdose. The lead author on the study, Brad Ray, also had really strong relationships with a lot of folks in Indianapolis, including the Minneapolis Police Department. And through conversations with them, it learned that overdose follow drug seizure, they were handing out more Naloxone than they typically would. So that got us kind of thinking about what exactly the mechanism might be, and what would be the best way to actually measure that. And so within this project, we have a few different aims. But the primary one was to really look at this mechanism between drug seizures and subsequent overdoses in sort of time and space of where that drug seizure event occurred. And I think using our methodology, and what we found, it was one of the first studies to really substantiate this association within time and space of a drug seizure event.

Manisha Krishnan What were the most important findings?

Grant Victor I think primarily, the most important findings were that there was a strong association between drug seizure and subsequent rise in overdoses following that event within time and space. Probably the most salient finding we had was that seven days following an opioid drug seizure event, and within about 500 meters, so a two to five minute walk from where that drug seizure occurred. We saw overdoses, fatal overdoses double in that time, which is, you know, we hypothesize that this might happen, but we weren’t sure exactly the magnitude. And obviously, that’s a pretty concerning finding. When you consider that on average, there were about three opioid drug seizure events a day in Indianapolis, and with stimulant related seizures. There were more than that, on average, I think around for four to five. So we’re not really talking about one isolated event a day. We’re talking about several over the course of a couple years. And knowing just where we are today with the overdose crisis, and sort of the historic rates of death by overdose that we’re seeing it is really concerning. We also did see in association with stimulant related drug seizure events, it wasn’t as strong it was mostly related to non fatal overdose events. But with with with a stimulant drug seizure, we saw that seven days and 100 meters from that event, non fatal overdoses increase significantly.

Manisha Krishnan Okay, so just to recap, fatal overdoses doubled in the week following an opioid seizure within like a short walk of where that seizure took place. That’s right. So why do you think that’s happening?

Grant Victor I think the main hypothesis here are a theory of exactly why this is happening is that we know the drug seizure at the very least results in drugs being displaced from a given area in a sort of low realized drug market. So when you disrupt that opioid supply, there’s disruptions to where folks can access drugs or more. So what drugs are actually able to get. And if you’re daily opioid user, you have a fairly short window of time, to where you have diminishing tolerance, you’re concerned about withdrawal. You know, you might be scrambling a bit, you might be concerned about potential fallout, you know, if you were close to someone who was involved in the seizure, or something like that, so there is a lot of acute stress on an individual following this event. And they also most likely need to seek out a new supply of drugs. So when you have sort of a diminishing tolerance of fear or withdrawal, you may go to a new supply that has a an uncertain dosage. And as a result, you see an increase in overdose risks. Even the drugs that they were accessing prior to any given seizure event, are going to be highly viable, as sort of a baseline that the toxicity of drugs in in illicit market right now are really, really toxic. And so this really just confounds those risks, and a magnitude we couldn’t quite measure. But we do see that it does result in poor outcomes related to overdose.

Manisha Krishnan Are there other instances where you see this happening? Like, for example, if somebody is sent to jail, or if they’re evicted, or maybe even when they go to rehab?

Grant Victor Absolutely, yeah, we published again out of Indianapolis a couple years ago, we had a paper come out that looked, looked at folks who were leaving jail. And what we found was we looked at one sample of folks who were released from jail in 2017. And we followed them for three years afterward. And each subsequent year following the arrest, this one cohort accounted for about 20% of all overdose deaths in Marion County, which is the county in Indianapolis, just that one cohort, wow, about a fifth of all county overdose deaths. And we found that those who are arrested on a syringe related charge had an even higher risk of death following the release that gets to your question, I think about the mechanism of diminishing tolerance, and not having adequate sort of harm reduction and treatment supports upon leaving something like you know, a jail, which in Marion County, and in most places have relatively few resources for those with opioid use disorder. So you do see a diminished tolerance, you go back into a drug market that you don’t know that well, it’s fairly unpredictable, and the risk is really high in that first two weeks or so following release. The same is true for folks who are admitted to an emergency department following a non fatal overdose, the risk goes up again, if tolerance is sort of curtailed during that that stay in the hospital. And if there again, aren’t adequate supports leaving a treatment center or emergency department, we see similar things as well, at a broader sort of community scale, when you talk about and this has been happening for probably the last 20 years or so where there were policy measures in place at the beginning of the overdose crisis when there was a lot of concern about prescription opioids. So there was a wave of policy measures that really made it more difficult to access, prescription opioids pain patients were kind of put out, what it did is it shifted entire market of folks who are dependent on prescription opioids, some of those with a legitimate, you know, prescription and medical concerns, to substances that are more risky. A prescription opioid is less risky than heroin that is criminalized. criminalized fentanyl happens to be more risky than criminalized heroin. And we’re seeing another phase with stimulants and with other sort of novel substances popping up like xylazine that we’re still working through, but the trend is pretty clear. And these things have been happening for, you know, 4050 years where the so called iron law of prohibition where you try to tamp down on something, and it really doesn’t go away, it kind of shifts in terms of drugs, most likely becomes more lethal. And so we do see this in other areas. And it’s really about how you want to measure the way in which drug markets are disrupted.

Manisha Krishnan Can we talk a little bit more about tolerance because that is something that comes up a lot in the context of overdoses? What happens physically, like how quickly does someone’s tolerance go down? And what happens if they try to start using again, kind of at the same level that they were before their tolerance dropped?

Grant Victor Yeah, tolerance can dissipate fairly quickly, especially relative to opioids. And we see this effects say in terms of a jail stay for one to two days, the tolerance can can diminish significantly, and that may occur prior to you feel drawl effects where you’re physically sick. And so the tolerance may may decrease and the individual who uses regularly knows their body quite well. Most likely, and then they may have a gauge on this, but they may not. In any case, when you go through a short period of abstinence, and return to us, it is really really dangerous given that none of the drugs you buy have a, you know, a nutrition label or any kind of information on them of what exactly you’re getting. It’s highly unpredictable, and it’s really toxic. And so if your tolerance is titrated, at any level, it’s going to increase your risk. And we see this bear out in our study, and in many others as well.

Manisha Krishnan Harm reduction policies are really polarizing. Right now, there’s crackdowns in San Francisco on public drug use. In Alberta. They’re considering involuntary rehab. So what are some of the takeaways that policymakers could take from your research?

Grant Victor I think our research provide an opportunity for policymakers to embrace science in a meaningful way. And I hope that they at least engage in conversation over our findings. And those in other studies. It does seem it is worrisome though, that we seem to be kind of falling back into old habits, not that we’ve ever really destroyed the war on drugs or an approach to 00 tolerance, tough on crime, that all of those sort of tropes that are used in terms of drug policy, but you know, we’re seeing a wave in New Jersey, for example, they just passed a bill to increase penalties for fentanyl possession. And these are really taking hold in a lot of different states here in the US. Harm Reduction, as always has been, like you said, a hot topic and controversial. So there’s a lot of work to do, and just around messaging, and what exactly we’re saying here, you know, we don’t want to diminish public safety, but we need to look critically at some of these, you know, sort of old habits that we’ve been doing for a long, long time that we’re finding maybe are killing lots of people in a situation where these deaths are preventable. You know, the Biden administration has been, at least relative to other presidential administrations, they have been a proponent of harm reduction. But, you know, there’s kind of this feels like a sleight of hand, when you see, you know, the federal budget, I think, for 2023, increased funding for interdiction and law enforcement, to stop the flow of fentanyl and to stop the flow of all these drugs. And it’s really kind of disheartening. And I think we have enough evidence now over 50 or 60 years to say, maybe let’s try something different, you know, with this study to one thing that really drew me to the question was just the scene of a press release following a drug seizure, these are cannon in drug policy. I mean, they are sort of the public facing messaging for law enforcement. And for any of those invested in, in stemming the supply of drugs, these are seen as a success story, you know, they have sort of picnic table laid out and various items on it that were seized, and and what if those events were actually really harmful? And how do we get that message to lay people and, and to policymakers? Because I think the general public, even really bright people who I talk to about this study that don’t work in drug policy, were surprised to learn that those actions may be antithetical to public health. So I think the common understanding still is that they at least are doing some good in removing drugs or firearms or paraphernalia off the streets. But they’re probably not really removing much of anything. It’s just a sort of replacement, and recycling of what was what was taken.

Manisha Krishnan So if seizures aren’t an effective tool in the fight against addiction and overdose, Where should our resources be going? What would be the first place that you would allocate funds?

Grant Victor Oh, well, that’s a good question. I think, right before allocate funds, I really think there’s such a downstream effect with a lot of these drug seizure events. Is there a fall? Is there an increase in crime, for example, after these drug market disruptions? Where are these events occurring? And are they their effects more disproportionately felt in various communities? I would venture to guess, although we haven’t studied it, you probably look at something based on just socio economic status of any given community. Are these effects felt differently or seizures concentrated in different areas? What are the implications there? So I think big picture for me and some of the co authors may disagree, but if we could simply cease the act of drug seizures, at least in an experimental way, for a year or two, I think that would be really interesting. And I think, to do that you have to have strong relationships with with law enforcement and other agencies who are working in that space, but it might be worth investigating and If the findings are promising, then I think we have a better idea of really where we can start allocating other funds. Short of that, you know, there are other options with Officer discretion and trainings. And these might help with the findings we have here in terms of when they do encounter someone who might be facing a misdemeanour, or nonviolent drug offence can discretion be used there to where the drugs aren’t taken from them, where they’re not arrested, and incarcerated. So that’s another option. And then there are, I think, probably the most viable and where the evidence shows most strongly is bolstering harm reduction efforts, especially in a state like like Indiana who have some of the most competent and passionate folks working in harm reduction that I’ve I’ve ever met. And they’re doing so and have been doing. So with really dancing around various legal and financial barriers. They’re hamstrung by a number of other factors, basically, operating Health Organization underground for decades. And so supporting those folks is really important. Flooding areas with Naloxone, it would be great to if we could open overdose prevention centers and things like that, which Canada has a lot more success with. And then we have in the US by far, so there’s a lot of room to improve in those areas. Another idea that we’ve had from this study is kind of looking at how we could use a sort of surveillance notification system, following a drug seizure. The best idea so far that we’ve kind of been working through is if police can alert, harm reduction or other community organizations in the immediate aftermath of a drug seizure event, where it occurred, what they took, etc. and flooding that area with with resources like Naloxone, substance use treatment, etc. There are issues there and it’s it’s always difficult to compromise when you have various groups working together in sort of opposite directions, it seems, one of which is that I think, just from our discussions, police are hesitant to say before a seizure event happens, because it might derail an investigation or something. So you’re still have a time lag there. And if you’re coming in, in the immediate aftermath of a drug seizure event, I think you risk losing some trust, or you at least have to manage, how trustworthy whoever is coming into that community right afterward. How are the community members gonna respond to that person? Is it? Are they gonna think it’s, you know, a trap? Are they gonna think it’s, you know, plainclothes officers or what? And if you remove the factor of trust, and what exactly do you do? And how, how many resources do you flood in these areas? Because it seems to me you’re constantly chasing these different, you know, interdiction efforts. So I think for me, it’s really important to get the message out that these are potentially harmful.

Manisha Krishnan Do you think that there is a police department out there that would agree to stop seizing drugs even in an experimental way? Like, does there seem to be that type of appetite or open mindedness? Because it’s such a, it’s such a departure from the norm?

Grant Victor Yeah, it is. I do think there’s, there’s some out there, certainly, I haven’t met them or really broach this idea in a serious way. But it is something that I intend to continue to pursue. There are New Jersey there, they’ve done some really creative things in Camden and Trenton, I think, also Newark, they’ve they’ve had some, some really interesting policing models that have shown a lot of promise. And so, you know, maybe if they’ve approached this issue in other ways, say, like crisis response for a mental health issue, which I think has gone a long way in how its criminalized and approach by law enforcement in the greater public opinion that this is a medical condition, and we need to, we need to do something different. Other than criminalize it. I think we can frame drug seizures, perhaps in the same manner. It’s really reversing a lot of stigma. I think also framing it in a way that is protective of folks who are responding to it in in sort of a sense of like, their occupational safety and things like that we you can kind of frame it in a way to say that this is maybe mutually beneficial for for both law enforcement and for for public health. You know, if, if we were to say if you take some time away from the drug seizure bit, it frees up a lot of time to pursue violent criminals, investigating homicides, ensure Homeland Security, all those things could be better focused in other areas. Maybe that message holds weight, but that’s purely speculation, but nonetheless, I think it’s worth pursuing. So we’ll see.

Manisha Krishnan I was gonna ask how significant Is this research because a lot of people in harm reduction have been saying this for a long time that the war on drugs is making this crisis worse, but just from an evidence perspective? How would you contextualize your findings?

Grant Victor In all humility, I think it’s, it’s huge. You’re right. A lot of folks who use drugs or who have been working the harm reduction space, these are really common sense. And probably maybe, you know, looks like a waste of time to some of them because they kind of felt this known this witnessed it for a really long time. But the importance of doing a study like this, and publishing it in A Public Health Journal, especially the American Journal of Public Health, can kind of use their voice in a way that’s backed by evidence in move this discussion into different spheres, you know, we can we can move this into sort of an academic sphere, which is important, but it’s probably more so important to again, move this into the lexicon of those who are in law enforcement, who are policymakers to show you know, they’ve been, it’s hard Reductionists have been on this for a long time, we’re able to substantiate a lot of what they’ve said. And now how do we support them? And how do we help them support those that they’ve been working with, for however long? So I think from that sense, it is a really important paper, it touches on you know, the content area is highly salient to our national well being drug overdose deaths along with with suicide, or dragging down our national life expectancy, which I don’t know, it feels pretty important to me to, to see what’s causing us to live shorter lives across the board. It’s something that that really kind of affects everyone. And so from a public health standpoint, I think it’s it’s one of the top issues we’re dealing with right now, among others. And from a public safety standpoint, public safety is an area of service that’s been scrutinized quite a bit in the last few years. And I think our intention was not really to scrutinize law enforcement, from the job or really, at all, it’s more so that this is an element that’s been going on for a really long time. As I said earlier, it gets a lot of press and praise. And so we kind of wanted to shine a light on the potential adverse effects of something like this and see about, I don’t know bring in some kind of, of change. And in trying to address these problems in a different way.

Manisha Krishnan What’s next, what other studies are in the works?

Grant Victor we have loads of qualitative data from this study, we’ve done interviews with law enforcement, public health officials and people who use drugs in both Indianapolis and Detroit. So we’re looking at moving some of those papers forward in the near future, which an academic speak is probably like two years, we also are conducting an analysis of how drug seizure events are reported within the media. And so we’re scraping media articles over the last decade that report on drug seizure events. Most of these are local events, most of them or at least some our press releases that are released through law enforcement, and then we get a press release from a local syndicate in that sense. And so we’re really just trying to create a database of drug seizure events to lay media because there aren’t really a national database that catalogs these events. So that’s, that’s kind of the next step in terms of just this project. But we’re also looking at replicating this study and other places, other cities. So it’s interesting to us to look at one is this effect, observed in areas that may be more or less conservative in their approach to drug policy, and policing. And are these effects held in areas that maybe have a slightly different demographic makeup and then a city like Indianapolis, and with that, also looking at other factors that might moderate the increase in overdose, following a drug seizure event. So was paraphernalia collected was firearms to this resulting overdose plus violence? Another interesting question that we’ve been kind of wrestling with something that’s coming from us through our interviews with people who use drugs is looking at these drug seizure events as a possible mechanism for displacement and gentrification. So those are a few ideas that we’ve been kind of tossing around. But generally speaking, we would like to replicate this in other studies.

Manisha Krishnan Super interesting. Grant, thank you so much for your time.

Grant Victor Thank you for having me. This was a lot of fun.

Manisha Krishnan Grant Victor is an assistant professor at Rutgers University. That was The Big Story. For more head to The Big Story. podcast.ca if you felt a certain way about this episode, let us know. The Big Story always loves to hear listener feedback. Reach us on Twitter at The Big Story FPN email Hello@TheBigStorypodcast.ca or leave a voicemail by calling 416-935-5935. The Big Story is available wherever you get your podcasts and you can get it on a smart speaker by asking it to play The Big Story podcast. Thanks for listening. I’m Manisha Krishnan in for Jordan. He’ll be back next week.