A study led by researchers at Rhode Island Hospital and The Miriam Hospital suggests that that one strategy for addressing opioid overdoses and deaths may involve the relationships between people who use illicit drugs and their dealers.
The study, which involved surveys and interviews with Providence residents who use drugs, found that many of them seek to protect themselves from harm by acquiring drugs from dealers whom they know and who either refuse to sell drugs that they know contain fentanyl or test their supply for the dangerous synthetic narcotic.
This new study, published in the International Journal of Drug Policy, was paid for by both The Miriam Hospital and the Center of Biomedical Research Excellence (COBRE) on Opioids and Overdoses at Rhode Island Hospital – with funding from the National Institutes of Health.
The same trio of researchers published a similar study in the International Journal of Drug Policy in 2017, which demonstrated that most people who use drugs in Providence do not seek out drugs containing fentanyl and struggle to control the contents and quality of the drugs they purchase—pushing back on early suspicions that fentanyl was entering the U.S. drug market as a result of user demand for “the ultimate high.” This study adds new depth to those earlier findings: while it is certain that fentanyl is being added to the drug supply somewhere in the supply chain, users can better protect themselves from fentanyl overdose by purchasing opioids directly from dealers who are known to them.
“The conventional wisdom that ‘we cannot arrest our way out of this’ is generally well accepted when we talk about people who are living with a substance use disorder. Our study found that we may be able to save more lives if we apply that logic to people who sell and trade drugs as well,” said lead author Jennifer Carroll, PhD, MPH, a fellow at The Miriam at the time of the research. “Our data shows that arresting someone for drug dealing can immediately increase the risk of overdose faced by the people they regularly sell to., who then may have to buy from a dealer with whom they have no relationship. In other words, our data suggest that enhanced criminal justice responses to drug distribution may actually cause harm rather than reducing the risks posed by substance use.”
Carroll, an adjunct assistant professor of medicine at the Warren Alpert School of Medicine of Brown University and on the faculty of Elon University, co-authored the paper with two prominent Lifespan opioid research experts. They are Josiah Rich, MD, an infectious disease physician at The Miriam Hospital and co-director of its Center for Prisoner Health and Human Rights, and Traci Green, PhD, MSc, an epidemiologist with Rhode Island Hospital and on the faculty at Brown and Brandeis universities. Rich and Green are co-directors of the COBRE on Opioids and Overdose, which was established at Rhode Island Hospital in 2018 with an $11.8 million grant from the NIH.
The study involved surveying and interviewing 92 individuals from 2016 to 2017. Of those, 51 discussed their relationships with drug suppliers and indicated that their experience with them was a key part of their strategy to avoid fentanyl. The just-published paper includes excerpts of interviews of anonymous drug users recounting their experiences in Rhode Island.
“This research gives important insight into the nature of the street-level drug market,” said Green. “It suggests taking an approach that considers dealer relationships and the social network, possibly as something to intervene on with prevention and harm reduction, rather than just as something to disrupt and dismantle.