Stimulant Summit | Interdiction Strategies, Public Health Partnerships Focused on Reducing Stimulant Use, Overdose Deaths

During the recent Cocaine, Meth & Stimulant Summit, Kevin Hall, Assistant Chief of Police, Tucson (Arizona) Police Department Patrol Services Bureau, Danielle Fenimore, Research Associate, Police Executive Research Forum, and Jon Zibbell, PhD, Senior Research Public Health Analyst, RTI International, delivered a presentation on the impact law enforcement drug interdiction strategies and public health partnerships are having stimulant use and overdose deaths.

During the session, Stimulant Summit attendees submitted questions for the presenters. Below are the presenters’ responses to those inquiries.

Question: Was it difficult you to convince others to carry Narcan? Some areas are not very welcoming of it. Do you have any strategies for building acceptance?

Hall: Initially there was some trepidation on the part of officers. However, at the time, there were some unsubstantiated claims regarding the dangerousness of fentanyl. We “marketed” the naloxone program as a safety initiative for officers who may come into contact with fentanyl. Once the officers began carrying Narcan they quickly found the need to administer it to the general public. We highlighted these “saves” or “reversals” with commendations and public praise. We also covered the standing medical order and legal liability concerns extensively in the training. This seems to have cemented Narcan as another necessary tool for patrol officers to carry daily. After 4 years, administering Narcan is as routine as any other activity the officers do on a daily basis (sadly).  

Do you think a broader national approach to deflection, should be considered in addressing the increasing problem of illicit drug use and crime? And can you elaborate on this?

Fenimore: The ubiquitous response to the overdose epidemic has shown a shift from punitive responses to substance use disorders to a recognition that substance use disorder cannot be treated criminally; as such those who work with individuals suffering from substance use disorders have all started saying that this is not a problem we can arrest our way out of. It seems that in many places, criminal responses (eg, arrest, jail, etc.) seem to only be a temporary solution which incapacitates the user, ultimately only providing a place to start withdrawal without offering any assistance for keeping someone from reverting to their habits as soon as they are free to go.

In the Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) workshop, we spoke with representatives from law enforcement and service providers from many different jurisdiction types, including federal, state, local, rural, and urban. They all said the same thing: Punitive approaches won’t fix the problem. It isn’t so much as a national approach to deflection, however, rather than a national shift in the understanding of addiction as a disease and the need for national conversations to remove stigmas and negative stereotypes of people who use drugs.

Has there been quantitative toxicology confirmation on the presence of fentanyl in black tar heroin in Tucson?

Zibbell: I cannot speak to Tucson specifically, but tar heroin in the Western regions of the country has contained (or been contaminated with fentanyl) for several years, including Texas. There are several practices for doing so, and the one that I have heard as of late is that fentanyl is mixed with water and the solution sprayed directly on the tar; that is, instead of mixing powder directly into the tar heroin. Either way, state and federal agencies have confirmed that Mexican-sourced black tar heroin is testing positive for fentanyl in the western regions of the US.

This being the case, it is incumbent on state and local public health agencies to include fentanyl test strips with naloxone in their overdose kits and do overdose trainings with people who use illicit opioids so they know how to use fentanyl test strips and naloxone to confront fentanyl toxicity. This way, people can test the heroin with fentanyl test strips before consuming it and then have naloxone at the ready post-consumption in case of accidental overdose. I have been referring this as full spectrum overdose prevention since it provides both pre- and post-consumption strategies to prevent both witting and unwitting fentanyl exposure and reduce accidental overdose.

Reference

Hall K, Fenimore D, Zibbell J. The impact of law enforcement drug interdiction strategies and public health partnerships on addressing stimulant use and overdose deaths. Presented at: Cocaine, Meth & Stimulant Summit; October 14-16, 2021; Virtual.