testRI: Developing a community-driven drug supply surveillance system in Rhode Island

Author: Alexandra Collins, Maxwell Krieger, Claire Macon, Abdullah Shihipar, Rachael Elmaleh, Lex Morales, Adina Badea, Rachel Wightman

Theme: Epidemiology & Public Health Research Year: 2023

Background: Drug supplies in the US are rapidly evolving and increasingly contain substances that heighten overdose risk and other harms for people who use drugs (PWUD). However, understandings of street-level drug supplies often rely on drug seizures, post-mortem toxicology data, and clinical non-fatal overdose data, which face significant reporting delays and do not adequately reflect experiences and exposures at the community-level.

Description of intervention: We developed a community-driven, near-real-time drug supply surveillance pilot program in Rhode Island to understand local supply changes and responses among PWUD. Data include longitudinal in-depth interviews with 50 PWUD, fieldwork, feedback surveys, and comprehensive testing of drug samples (i.e., paraphernalia, refuse, product) via LC-QTOF-MS. Data collection began in May 2022 and is ongoing. Data are rapidly disseminated to study participants, service providers, and the public through collaborations with the Rhode Island Department of Health and community partners.

Effectiveness: Since November 2022, we have maintained a real-time data dashboard and update repository hosted on the State’s overdose data dashboard, PreventOverdoseRI.org. Bimonthly supply updates focused on new findings are released and distributed in online and in print through statewide listservs, with materials (e.g., zines, infographics, data briefs) developed specifically for varied audiences including participants, providers, and peer outreach specialists. Through partnerships with harm reduction services, health care providers, State agencies, and community outreach workers, we have established networks for distributing timely updates about of the local drug supply information to the Rhode Island community, which have been used to modify overdose response messaging and harm reduction programming.

Conclusion and next steps: Enhancing state-level drug supply surveillance and dissemination infrastructure alongside community organizations is critical to improving awareness of local supplies and tailoring harm reduction approaches to be responsive to emerging trends. Improving surveillance systems is critical to providing more comprehensive understanding of drug supplies as they change.

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