New federally funded research examining drug policing and overdose data out of San Francisco suggests that law enforcement-related drug seizures are associated with increases in nearby opioid-related overdose deaths immediately following the police actions.
“The enforcement of drug distribution laws to increase public safety for residents in San Francisco may be having an unintended negative consequence of increasing opioid overdose mortality,” says the new paper, published on Wednesday by the American Medical Association (AMA). “To reduce overdose mortality, it may be better to focus on evidence-based health policies and interventions.”
Chances of a fatal overdose within 100 meters of a drug seizure rose within a day of police action, it says, and “elevated risk persisted for 7 days” afterward. Similar results were seen when the team analyzed overdoses within 250-meter and 500-meter zones around an earlier drug seizure.
“Within each space-time kernel, the strength of the association, all of which were statistically significant, dissipated the further away in time and distance from the law enforcement drug seizure event,” the report says, noting that the magnitude of the risk “diminished over time.”
Authors, from RTI International, the University of California, San Francisco, and the University of Washington, go further than saying the new findings reinforce previous research. They argue instead that no compelling evidence so far supports the idea that policing and seizing drugs is an effective approach to minimizing drug use or harms.
“To our knowledge, no evidence-based approach exists that shows supply-side interventions, such as policing and seizing drugs, reduces drug use or drug-related health problems,” their report says. “Instead, our study suggests that law enforcement interventions to arrest people selling drugs in the unregulated drug market and seize the drugs they are selling may have deleterious outcome on public health by increasing overdose mortality.”
Federal funding for the study came from the National Institute on Drug Abuse (NIDA) and the U.S. Centers for Disease Control and Prevention (CDC).
The five-person research team drew on mortality data from San Francisco’s Office of the Chief Medical Examiner and crime data from the San Francisco Police Department, looking at records between 2020 and 2023. The aim was to assess “whether location and time of law enforcement drug seizures were associated with subsequent opioid-involved overdose mortality,” the report says.
Authors said San Francisco was “of particular interest given that it is the second most densely populated large city in the US and has been engaging in heightened law enforcement drug enforcement since 2019.”
Around that year, fentanyl entered the drug supply, leading to record high overdose death rates, the report says. That led to more drug law enforcement and a more aggressive approach to policing by San Francisco’s mayor and district attorney.
During the study period, 2,674 “drug seizure crime events” took place, fluctuating between 16 and 106 actions per month. (The lowest period was in April 2020, at the beginning of the COVID-19 pandemic, when residents were told to shelter in place.)
Opioid-involved overdoses, meanwhile, accounted for 1,833 deaths during the study period, ranging from 25 to 59 per month.
Analyzing the two sets of data against one another revealed a meaningful relationship between a police drug seizure and fatal opioid overdose.
“We found that exposure to law enforcement drug seizure events was significantly associated with community spread of opioid overdose events,” the team wrote, “where the rate of future overdose events was higher in the days following and in locations around law enforcement drug seizure events in San Francisco.”
Authors noted that the findings reflect those in a similar study in Indianapolis, Indiana, which found that the rate of future nonfatal overdose was more than twice as high in areas close to recent opioid-related drug seizures.
The new analysis also found that overdose death rates went up during San Francisco’s COVID-prompted shelter-in-place ordinance.
“Isolating people in single room occupancy hotels was a good policy to limit COVID-19 transmission, but for those who were using drugs it meant there was no one there to witness and help them if they overdosed,” authors wrote.
“Ways to mitigate this problem,” it continues, “include installing overdose prevention sites in single-room occupancy hotels and providing a safe supply of drugs.”
Areas with “higher socioeconomic deprivation” also had higher overdose mortality rates, authors noted, aligning with findings from past research in various countries.
In terms of how to bring down opioid overdose rates, the new study points to “numerous evidence-based alternatives to law enforcement that address public safety and health concerning opioid use.”
Among them are easier access to medications for opioid use disorder (MOUD) or even providing users with “a safer supply of regulated opioids.”
“Randomized clinical trials have shown that providing a regulated supply of diacetylmorphine (the active ingredient in heroin) to people dependent upon opioids is a more effective way to retain people in treatment and to reduce their involvement in illicit drug use and other criminal activities than standard methadone treatment,” the report says.
Decriminalizing the possession and use of drugs is another approach—one that’s “brought down overdose mortality and HIV rates in Portugal without raising crime rates,” authors noted, “and early data from Oregon suggests that it did not produce increases in other crimes.”
“Another evidence-based alternative is to provide people with a supervised place to use drugs at overdose prevention sites,” the paper continues, “which have been shown to reduce overdose deaths and crime and social disorder in the neighborhoods in which they are placed.”
The research team said the findings speak to the need to rethink drug policies in response to sky-high overdose rates.
“As we are confronted with overdose rates that have contributed to a decline in US life expectancy since 2020, we need to consider how existing policies are contributing to this significant public health problem,” they wrote, adding:
“We recommend trying evidence-based approaches that have worked elsewhere, including providing a safe supply of drugs to people who are dependent, offering no-cost substance use disorder treatment on demand, drug decriminalization, and providing a safer environment to use drugs, such as overdose prevention sites.”
The new study, published in JAMA Network Open, comes on the heels of another American Medical Association-published report around marijuana and drug testing during pregnancy.
That research found that removing isolated marijuana use as a reason to order urine drug screenings during pregnancy “was associated with improved racial parity in testing and reporting” of test results to child protective services, “with no evidence of decreased identification of non prescribed, non cannabis substances” and “no significant association between the intervention and any measured neonatal outcomes.”
Another recent study that drew on federal crime data found that Atlanta’s move to decriminalize marijuana in 2017, contrary to warnings from some critics, led to a decrease in violent crime as police turned their attention to more urgent matters.
“Decriminalization led to a reduction in violent crime,” the report said, “likely due to police reallocating resources from marijuana enforcement to violent crime prevention.”
This past October, two other federally funded reports published by the American Medical Association examined issues of cannabis and pregnancy. One study found that cannabis use during early pregnancy was not associated with child autism, while the other found no association with increased risk for early childhood developmental delays.
As for other American Medical Association (AMA)-published research, a study late last year found that psilocybin-assisted therapy in a group of frontline clinicians during the COVID-19 pandemic “resulted in a significant, sustained reduction of symptoms of depression.”
A separate AMA-published study that received federal funding analyzed product listings on a popular marijuana advertising site and found that nearly half of all products were “flavored,” based on notes in the product descriptions. Researchers raised concerns that those flavors—along with cannabis-infused edibles, products like concentrates and merely listing retailers and products online—may make marijuana more appealing to young people.
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