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The Impact of Drug Seizures on Overdoses · Talking FACS

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  Welcome to Talking Facts, what you need to know about family,
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  food, finance, and fitness.
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  This nationally recognized, award-winning podcast is hosted by the University
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  of Kentucky Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  How many times have we heard on the news, in a raid today, police confiscated,
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  $250,000 worth of drugs and got them off the streets.
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  Our knee-jerk reaction is to think this is a good thing, meaning drug use will
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  go down because there will be less access to drugs.
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  Hello and welcome to Talking Facts. We have news you can use to strengthen your
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  family, your community, and our state.
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  I am Mindy McCulley, Extension Specialist for Instructional Support with Family
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  and Consumer Sciences Extension at the University of Kentucky.
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  My guest today, Dr. Alex Elswick, Assistant Extension Professor for Substance
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  Use Prevention and Recovery, is here to discuss drug seizures and what that
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  really means for those living with addiction. Welcome, Alex.
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  Good morning, Mindy. Thanks for having me back on your podcast.
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  What do drug seizures really mean for the addicted community?
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  Yeah, so I loved the intro that you gave there because I think when we talk
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  about drug use and addiction and people who use drugs, so much of it is really counterintuitive.
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  And, you know, in 12-step communities, in like the Alcoholics Anonymous program,
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  we like to say that addiction is cunning, baffling, and powerful.
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  And there's just something baffling and counterintuitive about it.
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  And so I think this study that we're going to talk about today about drug seizures
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  is the perfect example of that.
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  And it's also a perfect example of why we do what we do in extension in science
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  translation and why science is so important, because it allows us to not just
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  look at something at face value and say,
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  yeah, that seems like a good idea, but to actually test it and say,
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  but is it actually working the way that we think it's working?
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  And so that's really what this study was about.
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  Okay. So tell us more about this study. Yes.
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  So first, the idea for the study comes from a couple of things.
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  We know we've learned some lessons in the past about what happens when there
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  are big disruptions in the drug supply.
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  So some examples of this just kind of off top would be like,
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  When we responded to all the prescription opioid use by shutting down the so-called pill mills.
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  And then we saw an immediate increase.
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  People didn't have access to prescription pills, but we saw a huge increase in heroin use. Okay.
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  Filling the gap. So yes, we got pills off the street, but we didn't prevent
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  drugs from being used. Still people use drugs.
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  Another example is in Scott County, Indiana, in 2014, there was a big,
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  there was actually an HIV outbreak, an HIV epidemic.
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  And the reason for it was because there were a bunch of people who were snorting
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  a pill called Opana and the pharmaceutical companies created an abuse deterrent
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  formulation, but instead of, so that people couldn't snort them anymore,
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  but people who use drugs realized that they could melt them down and inject them.
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  And so overnight, all of these people who were snorting drugs,
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  which is already bad enough and harmful enough, became people who were injecting
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  drugs. And that led to all this harm.
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  So these are just a couple of one-off examples of when there are these big disruptions
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  in the drug supply, things don't get safer.
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  Things tend to get a lot less safe. And so that started prompting researchers
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  to ask that question about what happens when we get all these drugs off the street?
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  Like what actually, what's the impact for people who use drugs?
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  Well, and it makes me think about unintended consequences.
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  We don't think through what's going to happen after.
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  Well, that's exactly right. And I think back to your introduction,
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  one thing that's absolutely inevitably true is, you know, if someone says no
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  one's going to overdose on these drugs tonight because we got these drugs off
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  the street. That's true.
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  You got those drugs off. No one's going to overdose on those drugs.
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  But the question is, is that the same thing as saying now the community is safer?
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  Now no one in the community is going to overdose on drugs.
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  And the answer is really no. And that's part of what this study explored.
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  Listen to this title. I'm going to give you this fancy title,
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  and this sounds so epic and incredible,
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  but then we'll explain it and it's going to make perfect sense.
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  So the title is A Spatio-Temporal Analysis Exploring the Effect of Law Enforcement
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  Drug Market Disruptions on Overdose in Indianapolis, Indiana in 2020 to 2021.
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  So my goodness, right? Spatio-temporal sounds so fancy.
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  Those words, spatio means space and temporal means time.
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  So it's a space-time analysis. Basically what they did was they said,
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  let's look at big drug seizures.
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  They chose Indianapolis for a variety of reasons.
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  And something that I think makes it interesting for us is it's somewhat similar
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  to Lexington. Right. There's similarities.
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  So there's some real crossover here.
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  And they wanted to know for all of these big drug seizures,
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  whenever we get a lot of fentanyl or a lot of cocaine or methamphetamine off
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  the street, what's the impact on overdose rates within a certain amount of time
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  and within a certain distance of that drug seizure? Okay.
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  So, you know, a certain radius from where those drugs were seized and within 7, 14, 21 days.
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  Okay. And, you know, I think as you mentioned, logically, you would expect that
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  overdoses would go down because now there are fewer drugs on the street for people to overdose on.
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  Sure. But a study authors found is exactly the opposite.
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  Within at all the different time points, within 7, 14 and 21 days,
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  there were marked increases in overdose deaths compared to a control.
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  So compared to what what you would expect had there not been a big drug market
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  seizure. And that was for both opioids and stimulants.
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  So to put it in simple terms, what they found is that drug seizures led to an
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  increase in overdoses and fatal overdoses, not a decrease.
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  Okay. And how did they explain that?
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  That is the important question, because I think at face value,
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  there's a part of all of us that just want to resist that and say that doesn't even make sense.
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  Right. What I love, willing to break past a little bit of the discomfort and the stigma.
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  Right. Really think pragmatically. People who use drugs are people.
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  And so they're facing very real world constraints. So if you try to be pragmatic
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  about how they experience it, desperation is a bad thing, whether that's desperation
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  on an individual level or a population level.
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  So when, for instance, just when an individual gets arrested and their drugs
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  are seized, not a major drug seizure, just an individual and their individual using personal amount.
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  We know that that actually increases their likelihood of experiencing an overdose.
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  Sure. They leave incarceration.
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  They're at decreased tolerance. Right. So more susceptible to overdose.
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  And so on a population level, what happens is people who use drugs actually
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  form relationships with the people they buy drugs from.
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  What most of the research shows is that rather than it being this really predatory
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  relationship, mostly they begin with social connections.
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  So it might be people you already know. you start to develop relationships with
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  the people who sell you drugs so that you know kind of like consistency of product
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  what am I getting what dosages what's the quality.
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  When there's a big drug seizure and for instance the the dealer to whom you
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  were from whom you were buying drugs is arrested now you can't go to them to
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  buy drugs anymore now you don't have that consistent brand anymore which means
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  you're going to have to go somewhere else which increases the likelihood of
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  all kinds of bad things, harmful things,
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  of you getting ripped off and sold something that's not actually the drug that
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  you think it is, something that could be adulterated or contaminated.
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  It could be at a different dose.
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  It also means on the...
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  Supply side when a lot of the drug supply has been confiscated.
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  Now there are fewer drugs, but there are still the same number of people who
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  use drugs in that community.
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  And so in order to make that smaller supply still effective for that same number
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  of people, then what you end up having to do is to contaminate it.
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  And we call it like stepping on a supply, which means the idea of like cutting
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  it with baking soda or baking powder.
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  So it's like you can have a lot more product.
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  And so what that does is dilute the product. So then you have people who are
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  having to buy twice as much, which means they're paying twice as much.
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  So there are all these downstream effects, all these downstream effects that
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  you wouldn't think of until you start to consider pragmatically,
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  what are people actually experiencing on the ground?
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  What are people in our communities who are addicted using.
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  Maybe a simpler way of saying all of that is this phenomenon called the iron law of prohibition.
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  And I think parents kind of know this to some extent. The iron law of prohibition
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  says when you make something illegal, you don't necessarily make it go away.
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  You just make it go into the shadows. That makes it more harmful.
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  And so sometimes people use the analogy of a balloon.
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  So you can remove the drugs from, you know, remove some drugs from the market.
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  So it's sort of like pushing in on part of the balloon.
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  But all that does is create more pressure in another part of the market. Right.
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  Economics classes yes makes
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  this all makes make sense yes that's
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  exactly right it's it's it actually really is that it's macro 101 if you took
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  a macroeconomics class and you learned about supply and demand and honestly
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  more specifically if you learned about the economies of scale and yes and and
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  inelasticity of supply and demand i mean what what you realize is,
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  no matter what happens on the supply side, the demand doesn't change until you
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  do a recovery and recovery capital and all those things.
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  There are still the same number of people who are addicted to those substances in your community.
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  So that's always the limitation of anything that's a supply side strategy. Right.
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  It seems like it should be a no-brainer. It does.
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  Once you get pragmatic about it, it is a no-brainer. And so what's interesting
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  is, I think people have known this.
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  The study authors themselves talk about how they've been wanting to do this
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  exact study for a long time.
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  Not only did we already know all those things, I mentioned in the beginning
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  about the effect of disruptions in the drug supply, but also on an anecdotal basis,
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  talking to first responders, first responders see something similar.
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  And even just a couple of days before this study was published in one community,
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  I can't remember where in the United States,
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  law enforcement mentioned that there had been a big seizure in the community
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  and they were putting local emergency departments on notice because they intuitively
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  knew that one of the effects of that big seizure was going to be an increase
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  in some of these drug related harms.
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  And so it was kind of a really interesting example right before this study was
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  published of like, yeah, this
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  is really something that we're seeing on the ground in our communities.
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  So, that leads me then to what's the takeaway message for this research?
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  I think that is the big question. Because I think, depending on how you read
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  it, it's tempting to read the results of this study and say,
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  okay, Alex, so are you saying we should just not be getting drugs off the street?
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  And I don't think the answer is that simple.
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  I think, as with all things research, it's not one study that solves all these complex problems.
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  This is one little hint, one little point in the right direction.
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  And what this study suggests is that we need to rethink drug policy as it exists
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  today, that so many of the things that we assume are helpful are not just ineffective,
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  which is problematic enough when we're wasting money,
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  but may actually be harmful, may actually be causing part of the overdoses and
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  the drug-related harm that we're seeing.
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  So it could mean there's a need for access to a safer supply.
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  So things like medications for opioid use disorder, buprenorphine or methadone,
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  maybe relaxing some of those regulations so that people have more access.
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  It could be a variety of different things. But at the very least,
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  what it what it tells us we need to do is we need to revisit and actually test
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  the effectiveness of all these different kinds of drug policy to see is it actually
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  reducing harm or is it actually producing harm?
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  And I would think that the prevention part of your title.
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  Instead of going back to the 80s message of just say no, we need to say why
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  you need to say no rather than just giving a flat blanket.
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  Don't do it. Exactly right. Give them a reason and a good reason, too. Mm-hmm.
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  Alex, as always, thank you for enlightening me and enlightening our listeners
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  on a topic that is not talked about enough, I think. Yeah, thank you for giving attention to it.
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  Music.