In the 23 years since the opioid epidemic began, punitive drug policies have dominated the landscape. However, as the COVID-19 pandemic set in and worsened the already critical drug scene, evidence increasingly pointed to the effectiveness of a harm reduction approach.
Harm reduction efforts have been around for years, but they have been mostly “underground.” Just last week, New York City opened its first official overdose prevention center, also known as a safe injection site, that provides drug users access to a clean, safe space staffed with people who can help reverse overdoses if need be. The site, however, is privately run as the U.S. Supreme Court recently let stand a lower court ruling that a planned Philadelphia safe site was illegal under a 1986 federal law against running a venue for illicit drug use. Despite winning the case, the U.S. Justice Department indicated last month it might stop fighting such safe sites, saying it was evaluating them and discussing “appropriate guardrails.”
That would mark an abrupt change in stance at the federal level; although, the Centers of Disease Control and Prevention (CDC) has been employed an approach closer to harm reduction in recent years.
In September 2019, the public health agency launched the Overdose Data to Action agreement, which provides funds to health departments to obtain high-quality, comprehensive, and timely data on overdoses and use those data to implement prevention and response efforts. In April 2021, the program was boosted by the CDC’s announcement that federal funding could be used to purchase rapid fentanyl test strips, which determine if drugs have been mixed or cut with fentanyl.
Rapid detection strips like the fentanyl ones fall into the broader category of “drug checking,” which uses simple identification methods to tell drug users exactly what is in the drugs they plan to take. Drug checking services have been a part of Europe’s nightlife and music scene since the 1990s, but their presence in the U.S. is nominal. Epidemiologist Nabarun Dasgupta wants to change that.
Dasgupta, a fellow at the UNC-Chapel Hill Gillings School of Global Public Health, recently received a grant to work with colleagues across Carolina to develop processes and guidelines for chemical drug testing, along with systems to alert the public about potential dangers.
“Drug checking is an essential public health response to novel psychoactive substances and adulterants that are treacherous. [But] in the United States, only a handful of spectroscopy-based drug-checking programs currently operate,” said Dasgupta. “Our team is bringing together advertising, epidemiology and chemistry to generate timely data to reduce overdose deaths.”
To do this, Dasgupta collaborates with UNC’s Department of Chemistry Core Laboratory. Over the past year-and-a-half, the team has used state-of-the-art mass spectrometry to develop new methods to stay ahead of the ever-changing drug supply in North Carolina.
Now—with this grant—Dasgupta, co-led Mary Figgatt, and their collaborators will work with seven community-based harm reduction programs from all regions of North Carolina to conduct the first-ever street drug assessment focused on public health, backed by sophisticated machine learning techniques. They plan to release open-source chemistry lab protocols that will allow other university labs to test their local drug supply, as well.
Additionally, Dasgupta and team will use their previous experience with the Opioid Data Lab to create effective health communications using illustrations, as well as text and other strategies. Working with artists around the country, they will create an open-source library of hand-drawn illustrations for drug warning posters and social media.
“By pairing novel data collection with cutting-edge communication guidance, we offer a comprehensive solution,” said Dasgupta. “These techniques empower people who use drugs to make informed choices and reduce harm.”