‘The drug bust paradox’: Study shows opioid deaths double after police action

Police drug busts are strongly associated with a large and sudden spike in overdose deaths, according to a new study.

In the week following a major opioid bust, fatal overdoses in the same neighborhood in Indianapolis doubled, the analysis showed. Calls to 911 and the use of naloxone, the overdose-reversal medication, also spiked.

The new research, published this month in the American Journal of Public Health in a special section called “The Drug Bust Paradox,” does not draw a direct, causal link between police actions and drug users’ mortality. Still, it demonstrates a strong association between drug busts and overdose deaths, and its conclusions appear to break significant new ground in conversations about law enforcement’s role in responding to the drug crisis.

“Our study confirmed a hypothesis, or a very grounded belief, that many people have shared with me and my colleagues in the last few years — that includes people who use drugs, harm reductionists, first responders, members of law enforcement,” said Jennifer Carroll, a medical anthropologist at North Carolina State University and one of the paper’s authors. “Folks across the country have told us that they see overdoses spike after a major bust or after a lab closure or some kind of interdiction.”

The findings may have a simple explanation, the authors wrote: When police officers arrest drug dealers, their regular customers are left in the lurch. Facing agonizing withdrawal symptoms and with addiction treatment difficult to access, many simply find other dealers.

According to the researchers’ theory, those new dealers may sell drugs that contain higher levels of fentanyl or new adulterants altogether, like xylazine or lidocaine. And for people accustomed to a consistent supply from a consistent dealer, using newly sourced drugs can present a particular danger.

Similarly, when people who use opioids lose access to the drugs, even brief periods of abstinence can trigger not only withdrawal symptoms but also reduced biological tolerance. As a result, they face a two-sided risk: an urgent need to use caused by withdrawal, and an unfamiliar supply caused by a sudden shift to a new dealer.

Carroll said the findings are consistent with experiences she’s had throughout her career. While working as a postdoc at Brown University, interviewing overdose survivors as they recovered in the emergency room, she recalled asking patients: Why did you overdose today, of all days?

Among the most common answers: They couldn’t find their normal dealer, and had to rely on unfamiliar supply from someone they didn’t know.

Years later, while working as a scientific consultant to the Centers for Disease Control and Prevention, she recalled, she found that first responders also knew what to expect in the wake of police drug-enforcement actions.

“We met an EMT who told us that every time there was, in his words, a ‘big drug bust,’ they made sure to keep extra naloxone in their ambulances, because they had more overdoses,” she said. “We’re learning that it’s not just the drugs in the drug supply — it’s the fluctuation and unpredictability and the risk of misjudging your dose.”

The study found that only busts involving opioids were associated with a major spike in overdoses. Police activity targeting stimulants, by comparison, was associated with only a slight increase in overdoses.

The difference in fallout between opioids and stimulants is logical, Carroll said: Opioids are responsible for a large majority of overdoses, and sudden abstinence can cause excruciating, debilitating withdrawal symptoms. Stimulants, by comparison, are less likely to directly kill people using them.

The slight uptick in overdoses and 911 calls following stimulant arrests, the researchers theorized, may result from supply disruptions that lead stimulant users to seek drugs from other sources — not knowing that they may be tainted with opioids, namely fentanyl.

The findings were consistent across time and geography. According to the study, overdose deaths were elevated within a radius of 100, 250, and 500 meters of a drug bust — and were significant at intervals of one, two, and three weeks later.

The study was conducted using data collected in 2020 and 2021 in Marion County, Ind., supplied to the researchers by the Indianapolis Metropolitan Police Department.

The results are “not really a surprise,” said Leo Beletsky, an addiction researcher and professor of law and health sciences at Northeastern University.

“It underscores the reality that a lot of the time, in our illicit drug policy, there are untested hypotheses that get accepted as gospel, and law enforcement and politicians often repeat those hypotheses,” he said. “Things like: If we crack down on drug dealers, that’s the way that we’re going to reduce overdose deaths.”

While that theory is consistently espoused by lawmakers and law enforcement officials, Beletsky said the new study shows those views represent “fake news and alternative facts.”

While many advocates have argued for fully decriminalizing drug possession and taking arrest off the table as a consequence for drug use, the research paper’s authors were more measured in their conclusion.

Police officers should use more discretion in deciding who to arrest, they said, and lawmakers should “revisit the role drug policies play in perpetuating an overdose epidemic that is negatively affecting the nation’s life expectancy.”

Still, assumptions about law enforcement and police’s role in addressing the drug crisis continue to shape policy discussions across the country. Hundreds of thousands of Americans are currently incarcerated for drug-related offenses. Even in politically progressive areas like San Francisco, city leaders have turned to state police to step up arrests in neighborhoods known for drug use and open-air drug markets.

“A lot of policymaking in this space is more about optics and more about performative statements than actual evidence-driven policymaking,” Beletsky said. “That’s why you see people talking out of one side of their mouth, saying, ‘We can’t arrest our way out of this problem,’ then from the other side of their mouth, doubling down on approaches that have been proven to not be effective, and actually are most likely doing more harm than good.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.