To Understand Drug Trends, Ask Some Users

What we know about emerging drug trends pales in comparison to what we don't know, and therefore the field needs a much more thorough understanding of the drug-using community, Daniel Ciccarone, MD, MPH, said Sunday at the Cocaine, Meth & Stimulant Summit.

“Moral panic is our biggest enemy right now,” said Ciccarone, professor of family community medicine at the University of California, San Francisco, who believes the professional community remains too prone to stigmatizing drug users. “The drug users don't trust us. Let's check our attitudes.”

Ciccarone learns about drug users' experiences and beliefs largely through direct visits to “hotspot” communities where he and his research team interview users. Two visits to West Virginia in the past three years have revealed trends that counteract historical patterns, such as stimulants and opioids being provided by the same dealer and some users involved in co-use of heroin and methamphetamine.

Ciccarone pointed out that exhaustive crime lab test results from 2009-2017 in Ohio revealed that an opioid was present in only 8% of cocaine-positive samples and 2 to 3% of methamphetamine-positive samples. But the numbers are rising, and the emergence of fentanyl clearly is making all drugs deadlier, he said.

Fentanyl's presence gives life to the theory that some users may be shifting to methamphetamine because of the fear of fentanyl exposure. “Could we see meth as an organic response to the heroin crisis?” Ciccarone asked.

Move away from single-drug approach

Ciccarone urged the audience for his plenary session to think beyond looking at “waves” of a drug epidemic focusing on one drug alone, saying that the nation essentially is in the midst of one decades-long wave of drug problems.

He advocates more comprehensive solutions, suggesting that the successful public health approaches to combat HIV/AIDS have not been duplicated for addiction and overdose. These strategies should be focused more on people than on systems or individual drugs, he believes.

Adverse childhood experiences, community resilience, and partnerships between public heath and public safety all are important topics to address in a comprehensive strategy. “It's 'all in,'” Ciccarone said.