Overdose surges are a function of prohibition

The illicit drug market is in constant flux. People who use drugs are at the mercy of these changes – and any sudden shift in what is readily available can take lives.
An overdose warning sign in Dublin, Ireland, in 2023
An overdose warning sign in Dublin, Ireland, in 2023Courtesy Creative Commons

Early morning on April 29, emergency medical services responded to a call of a possible overdose in downtown Austin, Texas. Then there was another call. And another. And another. The calls came for young and old, placed from homes, businesses and on the streets. Overdose calls in Austin had recently been trending downward, but there were more than 50 overdose calls in less than 24 hours.

Ultimately, there were as many as nine deaths, most of which seem to have involved stimulants that contained fentanyl.

Ohio also knows overdose surges. We know them because they are the inevitable result of prohibition.

Rick Barclay, a Columbus-based harm reduction advocate, told me that in 2016 when the synthetic opioid carfentanil was in the supply in Ohio, it was a kind of triage. There wasn't enough naloxone – in most cases only enough to give one kit to a participant. At the time, Barclay managed the Safe Point syringe program. And when participants began sharing stories about people overdosing, he said it was clear that something different was happening, describing the feeling at the time as existing on a "conveyor belt of tragedy." Safe Point workers coached people on rescue breathing. They educated. They advocated. Everyone wanted to help, but they couldn't get resources fast enough. It was like constantly drowning and grasping at a life preserver set just out of reach.

In July 1926, at the height of alcohol prohibition, a Cleveland man died from bad liquor he and his wife had purchased in Buffalo. In all, 37 deaths were traced to that batch. That same year, more than 400 people died as the result of poisoned liquor, 23 during a Christmas Eve surge. 

The illicit drug market is in constant flux, changing because of taste and economics, but primarily politics. People who use drugs are at the mercy of change – and any sudden shift in what is readily available can take lives. Data released yesterday indicates that overdose deaths were down from 111,029 in 2022 to 107,543 in 2023 – a 3 percent drop. And yet, that’s still a horrific number. 

Claire Zagorski, a graduate research assistant at the University of Texas College of Pharmacy, got word of what was happening in April in Austin a few hours after the first overdoses. News spread through the grapevine of harm reduction and outreach workers that there was a new batch in town causing people to overdose. Outreach workers told outreach workers. Friends told friends.

And then people hit the streets to distribute naloxone. Texas Harm Reduction Alliance distributed more than 100 doses of naloxone. This is important because overdoses are more often reversed by people who use drugs or their friends and family. Austin-Travis County EMS said that in more than 80 percent of calls during the surge, people received naloxone before the arrival of EMS.

The truth is that when there is a surge, it's the grassroots, boots on the ground folks, along with people who use drugs themselves, who feel it the most. These are also the people who can do the most to educate and save lives.

Jaime Diaz, a peer services coordinator with Texas Harm Reduction Alliance, said that they talked to participants who told them about multiple overdoses. The organization is working to make more naloxone available for participants, and to check on unhoused friends. It has been an emotional few weeks. Diaz, like others doing this work, has lived experience. "I'm in long-term recovery, but I've od'd a number of times,” they said. “I shouldn’t be here; and I think there’s a special reason for me to be here."

And that reason could be doing the work of outreach, of connecting.

Zagorski said this sort of grassroots communication made a difference in part because they were able to get information from people working inside of agencies and sound the alarm. But, she said, "there needs to be better infrastructure for communicating top to bottom.”

Not surprisingly, one response from police and government officials will be to incarcerate people. "Anyone found responsible for distributing fentanyl faces potential charges of murder," Austin police Lt. Patrick Eastlick said at an April 30 press conference. Officials have also called in the Drug Enforcement Administration and the assistant U.S. attorney's office, he said.

Texas Harm Reduction Alliance issued a statement saying drug war tactics "will never be a solution to the overdose epidemic." Drug induced homicide charges will only make people hesitant about calling 911, and ultimately, distract the public from the policy failures that cause overdoses in the first place. What's needed, they wrote, is evidenced-based solutions: education, drug-checking, a better Good Samaritan Law, expanded MAT access, more naloxone in the hands of the people who need it, housing, safe supply, and an end to the war on drugs.

Jaime Diaz is hopeful. Diaz told me that they believe the younger generation has taken note of the failed drug war tactics and sees a different world is possible. But with prohibition still in place for now, more overdoses are inevitable. So, Jaime always carries a black pouch made of nylon over their shoulder containing two doses of Narcan. It has become a necessary part of their outfit.

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