Thread by @veruka2

New research (by me & colleagues) on the MAHOR role that people who sell/deal drugs play in protecting people who use opioids in the U.S. from fentanyl exposure and overdose.
The tread below unpacks our findings and implications:
1/

sciencedirect.com/science/articl…

What's that you say? Drug dealers are helpful? They actually make people safer? YES. In fact, that is indisputably what we found through this research. In the words of one of the fantastic (and also opioid dependent) people we worked with on this study...
2/

"[My dealer's] like, Everybody's got fentanyl, and I don't want to buy it. So he's not even picking it up. He's like I'm not going to serve people that. So, there's actually dealers that care. I know you guys don't think they care; they actually care...they're [like] family."
3/

Here's a quick and dirty breakdown of what we found and why it matters. (1) the VAST majority of opioids sold in this study are what PH scientists call "social supply." People who use buying and selling with/among each other. For $. For drugs. Because it's etiquette, it's kind
4/

Why does this matter? B/c when we enact policies like Drug Induced Homicide (bit.ly/2VLIYdl) we assume that low lvl dealer and ppl w addx are not going to be swept up. This is about BIG dealers! I hear politicians/policy makers say this all the time.
5/

This study suggests that low level dealers are the vast majority. BIG dealers are the minority. If you arrest someone for drug distro, the overwhelming probability is that you have picked up a low level/addct'd person. Yet they often get charged and sentenced to life anyway.
6/

(2) People who sell drugs and are engaged in social supply often go to GREAT LENGTHS to ensure that the ppl they sell to are safe. Testing drugs b4 they sell. Refusing to sell fent. Offering refunds. Warning clients. DELIVERING NARCAN TO CLIENTS. Dealers are key to prevention.
7/

Why does this matter? Because dealers are doing what our government refuses to do. Illicit fentanyl is dangerous not only bc it's fentanyl, but also bc it is *criminalized*. Criminalized = unregulated. Unregulated = ZERO consumer protections. No consumer protections = unsafe.
8/

With regulated products you always know what you're getting and can make safer choices. Your yogurt is labelled with fat content. Your rx drugs come labelled with dosage. Even your beer comes labeled with %ABV. Ppl who use opioids have no such luxury-THEY COULD! but they don't
9/

This study demonstrates that ppl who sell drugs are *THEMSELVES* taking on the role of a consumer protections bureau (cough @US_FDA cough) because no one else in our government is legally allowed to...or interested in doing so apparently.
10/

What does this mean for public health? For our communities? For our friends? loved ones? ourselves?
Simple: dealers help people avoid fentanyl. Losing contact with a dealer means more risk of fentanyl exposure. More unsuspecting fentanyl exposure means more overdose.
11/

"...removing access to trusted dealers may put clients...at immediate risk of overdose. Indeed, for many individuals in this study, the inability to access a trusted supplier was reported as the specific event that precipitated their most recent overdose."
12/

"...good-faith attempts to disrupt macro-level drivers of the opioid-overdose epidemic (police sweeps, dealer take-downs, sudden pain clinic closures, etc.) may in fact only result in creating more harm among those who are already at risk"
13/

"Put bluntly, arresting a dealer may directly contribute to overdose within their client population."
14/

Friends, our society supports ⬆️ criminalization of substance use and distribution, supports laws that target "dealers" (i.e. ordinary ppl with addx), supports ⬆️criminal risk for people who are doing more to protect each other than our health care system. WHAT ARE WE DOING??
15/

It's beyond time to start having some hard conversations with ourselves. What, really, REALLY are our goals when we respond to substance use?
If our goals are to shame ppl who use drugs by treating them like garbage and depriving them of rights, we're on the right path.
16/

If our goal is to PROTECT LIFE. If our goal is to SUPPORT people who need support. If our goal is to REDUCE HURTING. Reduce death. Reduce harm....then we are shooting ourselves in both feet while trying to sprint towards the finish line by relying on criminalization.
17/

This study and countless other studies tell us in VERY CLEAR TERMS that our policies are responding to an imagined drug crisis, not to the realities of substance use and addx as they exist in the real world. We, as a society, are lying to ourselves.
18/

We need to let go of our moralizing and embrace compassionate pragmatism.
--decriminalize social possession and distro
--open safe consumption sites
--massively expand medication access
--REGULATE THE G. D. DRUG MARKET ALREADY.
19/

Opioid overdose has never EVER been a moral issue in the U.S. It's not a health care problem. It's not a criminal problem. IT IS AND HAS ALWAYS BEEN A CONSUMER PROTECTIONS ISSUE. If our goal is protecting life, we have *got* to start treating it like one.
20/