ANTH Assistant Professor Part of a $2.5M On-The-Ground Study of Homeless Populations’ Polysubstance Use  

A University of Maryland anthropologist is helping investigate the United States' overdose crisis by taking to the New York City and San Francisco streets to better understand how and why homeless persons use fentanyl with stimulants like cocaine, crack cocaine and methamphetamine.

Assistant Professor Andrea Lopez’s efforts are part of a five-year study—led by Yale University's Ryan McNeil and University of California San Francisco's (UCSF) Kelly Knight—that was awarded $2.5 million from the National Institute on Drug Abuse earlier this semester. As a co-investigator, Lopez will help document how this especially at-risk population is engaging in a relatively new and deadly phenomenon experts are calling “polysubstance use.”   

“We’re seeing this transition now in terms of national data where the toxicology reports of a lot of deaths that are reported have a combination of stimulants and opioids, but those toxicology reports don’t explain what’s going on on the ground,” said Lopez. “There are multiple pathways that define what a person’s drug use trajectory is, and those different pathways and intersectional dynamics define what a person’s trajectory is in terms of their risk for drug use, morbidity and mortality.” 

While encouraging physicians to reduce potentially unnecessary opioid prescriptions has been one of the country’s most emphasized crisis mitigation strategies so far, Lopez points out that this strategy only addresses one possible pathway, and therefore only a fraction of those who are historically most impacted, and who are dying from drug overdoses. Plus, she says, this focus does not address the majority of structural issues that marginalized populations face in relationship to their drug use, including racism and social marginalization.

“There are a lot of issues around racism and marginalization that intersect and prevent a person from being able to get opioids from a clinician in the first place. The goal here is to understand some of those other pathways within the homeless community, and also think through how those drug use patterns evolve in response to changes in housing status, changes in engagement with overdose prevention or treatment, and the trajectories associated with those patterns,” explained Lopez.

Between street-based study recruitment and visiting some of the centers for opioid treatment that Lopez, Kelly Knight and Ricky Bluthenthal, from the University of Southern California (USC), have worked with during past projects, the researchers hope to walk away with an intimate understanding of how homeless persons’ polysubstance use occurs, and is impacted over time by various structural conditions.

“When you really center and engage people who use drugs as a way to inform how we understand overdose vulnerability and the impacts of access to treatment, access to housing programs and access to overdose prevention, then you can really understand what those decision-making processes are and create better, more robust prevention programs and interventions,” said Lopez.

Lopez was recently appointed to the Maryland Department of Health's Standing Advisory Committee on Opioid-Associated Disease Prevention and Outreach Programs for her related contributions to engaging with and studying the structural needs of people who use drugs. She was also the recently elected Vice Chair on the Board of HIPS, the largest harm reduction direct service provider in Washington, DC. Lopez has also published on racial disparities as they intersect the overdose crisis as well as the co-use of methamphetamines and opioids. 

“This is critically important work that will save lives and reduce harm among multiple marginalized communities, with policy implications that extend beyond the two study sites,” said Barnet Pavão-Zuckerman, Professor and Chair of the Department of Anthropology. “This is applied anthropology at its very best.”

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Published on Thu, Dec 22, 2022 - 10:20AM