Researchers recently conducted a year-long study from 2020 to 2021 to explore the potential link between police operations aimed at drug disruptionsâsuch as the arrest of drug dealers and confiscation of illicit substancesâand subsequent increases in opioid overdose incidents. Specifically, the study sought to uncover whether the region affected by the law enforcement intervention saw a spike in overdose issues following the operation.
When managing opioid overdoses, a rapid decrease in tolerance is a major concern among public health officials. When people cease their drug use, they may enter withdrawal, and their bodies become less tolerant of the substance. If they resume drug use, the risk of overdose is amplified. Researchers proposed that disruptions caused by law enforcement, which could limit or change the drug supply entirely, might lead to increased overdose risks due to reduced tolerance or altered accessibility.
Senior Justice and Behavioral Health Researcher at the Research Triangle Institute in North Carolina, Brad Ray, led the study. The authors explain the mechanism in the following way:
âThis same mechanism has been documented as occurring in the illicit drug market following disruptions from an arrested supplier and consumers contending with new and potentially unfamiliar products. The impact of these drug market disruptions may be particularly salient for people who use opioids, who can experience painful withdrawal symptoms and diminished biological tolerance even after short periods of abstinence.â
With diminished tolerance and potentially inconsistent dosage in the new drug supply, users are at a heightened risk for accidental and possibly deadly overdoses.
To test their theory, the research team conducted a retrospective, two-year, population-based study using administrative data from Marion County, Indiana, a region home to nearly one million residents and the state capital, Indianapolis. The study used information from three sources: the Metropolitan Police, the Marion County Coronerâs Office, and local EMS services. These resources provided data on drug seizures, fatal overdoses, and non-fatal overdose calls, including requests for naloxone, a medication used to counteract opioid overdoses.
The researchers collected data on opioid and stimulant seizure events because removing stimulants from the black market also leads to a rise in overdoses. When the existing stimulant supply is depleted, itâs often replaced by a new batch potentially laced with opioids such as fentanyl. This sudden change can lead to overdoses, especially among people who primarily use stimulants. The team found an increase in overdoses in areas where drug market disruptions occurred.
âThe difference in spatiotemporal clustering of all three overdose event rates before and after opioid-related seizures was higher than expected,â the researchers write, âalthough this pattern of association was less consistent among stimulant-related seizures.â
âThis is consistent with our hypothesized mechanism because persons with opioid use disorder who lose their supply will experience both diminishing tolerance and withdrawal, whereby even the anticipation of painful symptoms may lead them to seek a new supply while discounting risks that stem from the differences in potencyâŠ.â
While the researchers cautioned that these statistics donât prove causality, the observed patterns are statistically significant. Potential confounding factors include community-level issues not accounted for in the research model, socio-cultural differences between Indianapolis and other large urban areas, and possible police bias towards areas already facing higher overdose risks.
The researchers propose potential strategies to mitigate the increase in overdoses following law enforcement interventions. They recommend distributing naloxone, promoting drug-checking services, and opening overdose prevention sites. They suggest:
âNaloxone distribution, drug-checking, and overdose prevention sites are strategies first developed and implemented by people who use drugs that can be facilitated or enhanced by law enforcement cooperation through exceptions or âcarve-outsâ of drug criminalization to protect public health. These practices provide people who use drugs with shelter from the harms of drug policy but fall short of reassessing and revising policies that might prevent these harms in the first place.â
However, the question of law enforcementâs role in mitigating drug-related issues remains. The researchersâ study contributes to a growing body of literature suggesting that current drug policy may do more harm than good, with the researchers stating:
âOur study adds to a growing body of literature that suggests drug criminalization and supply-side interdiction might produce more public harm than public good. This casts doubt on the core assumption of state and federal drug policy and suggests that police officers intending to protect the publicâs health and safety may be inadvertently exacerbating harms such as fatal overdose.â
This research includes a meta-analysis that studied the effects of drug criminalization, sometimes called the âDrug Warâ or âWar on Drugs, and social determinants of healthâfactors outside an individualâs control that significantly affect their well-being.
In a broader context, issues of drug criminalization tie into the social determinants of health. These could include everything from environmental pollution to employment instability. A punitive approach to drug policy may worsen these underlying social determinants, exacerbating public health issues rather than resolving them.
The research concludes:
âRather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment.â
Continuing to use punitive interventions to cure drug-related public health issues may exacerbate those issues that caused drug use in the first place.
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Ray, B., Korzeniewski, S. J., Mohler, G., Carroll, J. J., Del Pozo, B., Victor, G., … & Hedden, B. J. (2023). Spatiotemporal Analysis Exploring the Effect of Law Enforcement Drug Market Disruptions on Overdose, Indianapolis, Indiana, 2020â2021. American Journal of Public Health, 113(7), 750-758. (Link)
