Heller School Opioid Research Collaborative collects drug supply data
The goal of the project is to create better informed public health and safety policies.
The Heller School for Social Policy and Management’s Opioid Policy Research Collaborative provides a space for researchers to pursue projects that are broadly connected to opioids. One innovation that has come out of the OPRC is Director Traci C. Green and her team’s work on changing methods to collect data on the drug supply to create better informed policies.
The Massachusetts Drug Supply Data Stream falls under the OPRC and was created to study the local illicit drug supply to better inform public health and public safety policies. MADDS provides a free website and app called StreetCheck that is designed “to develop and standardize sample collection and reporting for community drug checking programs.” The StreetCheck app helps programs with their community drug checking activities and can be tailored to a specific drug checking program and lab partner arrangement. StreetCheck started in Massachusetts, grew to more locations in the Northeast, and is open to collaborating with communities all over the country.
MADDS is a “state-funded collaboration,” according to the StreetCheck website, “between Brandeis University researchers, the Massachusetts Department of Public Health, various town police departments and local community partners.” MADDS includes an advisory board that analyzes drug trends, produces actions based on the data, and advises on to whom these communications should be sent to. The Harm Reduction Commission, established in August 2018 by former Gov. Charlie Baker (D-MA), addresses substance use disorder by making recommendations on harm reduction opportunities. MADDS is part of the state’s response to the commission’s suggestions.
MADDS’ first trial run in 2019 started in Boston and New Bedford and has since expanded to Quincy, Lynn, Greenfield, Brockton, Gloucester, Fall River, Northampton, Lawrence, Beverly, Cape Cod, Essex County, and Berkshire County communities. MADDS is funded by grants from the Centers for Disease Control, the Substance Abuse and Mental Health Services Administration to the Massachusetts Department of Public Health, and the Bureau of Substance Addiction Services.
Community drug checking programs not only lead to improved public health and safety measures, but they also transform the way people collect information on the chemical substances in communities’ drug supplies. In a Jan. 30 interview with the Justice, Green explained that there is no formal source of data on drug supply, so researchers have to wait until adverse situations, such as hospitalizations, deaths, and arrests occur in order to gain data. Green thinks that this method is “unethical and we need a better and more accurate look that is more on the preventative side and forward thinking.” By compiling drug supply data through collecting samples, researchers can gain access to data earlier and enact preventative measures.
Moreover, because the street drug supply is unregulated, community drug checking can fill in information gaps and inform drug-users what substances are in their drugs. Increasing awareness among drug-users can cause them to change their consumption behaviors and reduce their risks of negative health outcomes.
In the interview, Green discussed three emerging trends in the drug supply. 4-Fluorofentanyl and Despropionyl 4-Fluorofentanyl — a fentanyl analog and an intermediary
in fentanyl analog production, respectively — were found in heroin and fentanyl samples. According to the CDC, analogs are “drugs that are similar in chemical structure or pharmacologic effect to another drug, but are not identical.” This pattern appeared during the pandemic, and the addition of these drugs heightens the toxicity of the sample, leading to concerns about overdosing.
Furthermore, the MADDS team discovered a dramatic rise of the veterinary tranquilizer xylazine in fentanyl and heroin drug supplies. Green stated that in 2021, one third of samples of heroin and fentanyl contained xylazine. Xylazine can cause oversedation in humans and prevent them from moving for four to five hours at a time depending on the dosage. If people use drugs with xylazine outside in the cold, there is a risk of frostbite and hypothermia; on the other hand, if it is hot outside, drug-users risk excessive sun exposure. The risk of skin ulcers at the injection site and around other cuts increases when using xylazine, and ulcers can lead to infection or necrosis.
A synthetic cannabinoid called “ADB-BUTINACA,” or “ADB-BINACA,” was detected in dope, heroin, and fentanyl samples. Reported symptoms included seizures, heart attacks, acute kidney injury, pulmonary edema, stroke, delirium, psychosis, rapid loss of consciousness, vomiting, and multiple organ failure. Green stated that synthetic cannabinoids are not typically injected. Knowledge on the presence of synthetic cannabinoids in the drug supply is helpful to law enforcement when responding to situations where people are using, so they use deescalation techniques instead of forceful alternatives.
MADDS’ work influenced efforts to increase access to safer drug use materials, fentanyl test strips, and more comprehensive drug testing.
During the interview with the Justice, Green highlighted the importance of raising awareness among college students and young people in general about drug checking services. Green pointed out that in Massachusetts there are no age restrictions for acquiring harm reduction materials and services, buying syringes and naloxone at a pharmacy, and using drug checking services. One of the concerns for young people is the use of counterfeit pills, and Green emphasizes the importance of using drug checking services to reduce risks. She mentioned some of her colleagues’ work on college campuses, and Brandeis does not have a drug checking program yet. Moreover, Waltham is not a community that MADDS works with directly, but Green wants to change that. MADDS also wishes to expand to Middlesex County, which is where Walthm is located, and Worcester. The more sites that open up, the less difficulty people have in trying to find a community drug checking site near them. “Frankly there is [a] need for drug checking services pretty much in every community across the country,” Green stated.
Drug policies can be a divisive topic and lead to a lack of empathy; however, Green emphasizes the need for compassion and understanding. “All of these programs in the community are always best done in partnership with people who are actively using drugs,” Green highlighted, and paying attention to drug-users’ perspectives is essential. Creating a safe space to talk about drug-related experiences and having “a high degree of tolerance and a big heart” can produce greater insights into the best ways policymakers, public health authorities, and law enforcement can address the opioid epidemic.