Conducting Research in the “Real” World Laurie A. Drapela, Ph.D. Washington State University Vancouver March 7th, 2002

The Size of the Problem

The Research Question 1989-1999: Sharp increase in heroin deaths (Multnomah County) RAP – Recovery Association Project Advocacy organization: housing for persons in recovery from opiate addiction Approaches Multnomah County Board of Commissioners (BCC) DO SOMETHING ABOUT THIS!!!!

Methodology Two approaches: Quantitative data How many heroin deaths are there? Who is dying from heroin overdose? Qualitative data How do heroin overdoses occur? Mark: I also mentioned ADAM data (Arrestee Drug Abuse Monitoring Program) and DAWN data (Drug Abuse Warning Network). I mentioned these in the course of discussion with students about how we could find out the prevalence of drug use in Multnomah County.

Fatal Overdose Profile (N=99) Males: 74% White: 92% Ages 35-45: 54% long term users Criminal Justice System Involvement: Approximately 25% of persons were on probation or parole at the time of death.

Ethnographic Investigation How do heroin overdoses occur? Subjects & Setting Portland, Oregon 10 current heroin users 8 former users 4 narcotics officers

Market Factors Heroin is cheap! Potency is highly variable Across dealers Within a given dealer across time Within a given batch of black tar heroin We talked about how the fact that Portland is exclusively a black tar heroin market and how black tar heroin is processed. “stepped on” = slang referring to the fact that batches of BTH are often remixed as they move up the coast from Mexico.

The Results Heroin OD’s (ME Records; Quantitative) Qualitative Mostly older white males Deaths: mostly at home. Only 1 in 6 occurs in a public place Polydrug is a problem: 36% of overdoses! Qualitative Many users are afraid to call 9-1-1 when witnessing an overdose Benzos Jail/treatment

Short-Term Recommendations To the Medical Examiner: Revise toxicology screening Better document polydrug use in heroin overdose deaths To the Medical Community: Bulletin to the medical community Be conservative when prescribing benzodiazepines! Ask about drug history!

Harm Reduction Accepts, for better and for worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them. (www.harmreduction.org)

To the User Population: Shoot straight: no chasers Know your dope Don’t shoot up alone Control your kit You can always do more, but you can never do less ID an OD 9-1-1 is a safe call To the Police: Greater police discretion re: arrest for PCS