A Career Dedicated to Ending Overdose Deaths

Two decades ago, Brad Ray realized how important naloxone is. He had been trying to wake up a loved one in his living room in Chicago for nearly an hour when he found small bags of white powder. Frighted about what the legal outcome might be, he risked calling 911, and when EMS arrived, they injected a medication into his friend, and he was immediately revived. It was naloxone, the opioid overdose antidote, and to Brad, who was certain his friend would die, it seemed like a miracle. 

His friend survived a heroin overdose that day, and continues to thrive today, but the incident was a jarring introduction to what would later be coined the “overdose epidemic”. 

As a first-generation college student, Brad wasn’t certain where a degree in Sociology would take him, but after seeing naloxone work, he needed to share his new knowledge about this life saving drug. 

Brad was fortunate to find mentorship with Dr. Greg Scott, a sociologist at DePaul University who brought him into his research with injection drug users at the Chicago Recovery Alliance. There, Brad learned about harm reduction and syringe distribution and met Dan Bigg, a public health pioneer, who inspired him with kindness toward people who use drugs and an elegant definition of harm reduction: any positive change.

As part of his master’s thesis, Brad worked with the Chicago Department of Public Health to code toxicology results from overdose deaths. His first publication focused on mapping trends and correlates, and he was encouraged to pursue a career in research. 

In 2006, he started a PhD in Sociology and Anthropology at NC State, but at the time public awareness and research on overdose was still limited. There were few sociologists studying overdose prevention, so he pursued a dissertation on stigma and the criminal-legal systems. However, when he started a faculty position at Indiana University in Indianapolis in 2012, he immediately developed a research partnership with the county coroner and started collecting toxicology data to understand patterns in overdose deaths. 

Interdisciplinary Challenges of Overdose Prevention

Brad has organized his career around interdisciplinary collaborations with researchers and practitioners. For example, in 2013, as a professor in a criminal justice department, he was able to work with local EMS to facilitate and study the uptake of naloxone to police officers.

“A decade ago, the idea that everyone should have naloxone was controversial, but police were first responders, and given the criminalization of drugs, they were on the front line of an emerging public health crisis,” he said. “Everyone used to say there is no way naloxone could ever be available to the public, but today you can buy it at a pharmacy without a prescription.” 

With toxicology results, Brad was early to identify fentanyl in overdose deaths in Indiana. He started a process where he would link these records to other administrative data to identify touchpoints – settings where people are prior to a fatal overdose. It was through this work that he saw the harmful effects of incarceration, with his research showing that at least one out of five overdose deaths were people recently released from the county jail. 

“It’s well known that when people have developed a chemical dependency to opioids that they can no longer obtain, they might shift to alternative sources or different drugs, particularly to avoid withdrawal symptoms,” says Ray. “People in jail are rarely provided evidence-based medications and with biological changes in tolerance, they are more suspectable to overdose if they resume use, particularly at pre-incarceration levels.”

Brad moved back to Michigan in 2019 and started a position at Wayne State University in Detroit where he led a team of social workers in implementing medications for opioid use disorder in jail facilities across the state. It was clear to Brad that treatment was not going to be enough to reduce overdose deaths. He again pivoted to the opioid overdose antidote, naloxone, by designing a vending machine to distribute free naloxone to the public. Dozens of jails across the country now have these vending machines with plans to implement a hundred or more across the city of Detroit.

Doing the Groundwork to Reduce Overdose Deaths

Brad joined RTI in the fall of 2021 after a decade in academia. He continues to work toward the goal of reducing overdose deaths. His research agenda is driven in large part by listening to people on the ground to better understand what is happening. For example, when first responders in Indianapolis told him that they used more naloxone after police drug seizures, he saw a new opportunity to research drug supply disruption. 

In his recent publication by the American Public Health Association, Ray and his colleagues studied whether law enforcement efforts to disrupt local drug markets increased overdose events within the surrounding area. The cohort study took place over a 2-year span and compared the frequency of opioid drug seizures with the changes in fatal and nonfatal overdoses. As part of the study, Brad also conducted interviews with law enforcement. 

“We need to recognize that part of the problem with policing in America is that we are giving them impossible tasks,” he said. “Asking police to enforce zero-tolerance drug policies, while serving as street-corner psychiatrists in a society with a dysfunctional healthcare system, and people self-medicating with mind-altering chemicals, is a recipe for disaster.” 

Overdose death rates have been consistently increasing for more than two decades. In order to have any meaningful reduction, Brad thinks we need to listen to people who use drugs. 

“It’s not going to be enough to give these experts a seat at the table, we need them to drive the agenda on how to keep folks safe.”

A Career Full Circle

One of the major draws of RTI for Brad is the work that Alex Kral, an epidemiologist, and his collaborators have done with overdose prevention sites in San Francisco. While he expressed sadness in the lack of support for these settings, he also knows the importance of translating evidence on effectiveness.

Part of doing this work is having thick skin,” he said. “There is a lot of stigma, fear, and misinformation around drug use. When people are unable to accept the evidence about these sites, that they stop people from dying of an overdose, I try and remember people in my career who were once opposed to distributing naloxone in the community that are now doing exactly that kind of work.

Brad was able to visit the site in San Francisco last year before it closed and worked with Kral and his colleagues on a paper about the use of oxygen to reverse overdose deaths. 

“It was really beautiful, seeing people socialize in a space where they could feel safe and use without fear of death,” he said. 

Now a resident of Minnesota, Brad volunteers with his local syringe service program (Harm Reduction Sisters) and is excited about the potential to research drug policy changes there. Minnesota has become the second state to officially support overdose prevention centers (Rhode Island being the other) with Governor Tim Walz mandating the Commissioner of Human Services “establish safe recovery sites that offer harm reduction services and supplies, including but not limited to safe injection spaces.” 

Brad recognizes that these sites are not a magic bullet. They aren’t going to address the social problems that drive risky drug use, but they keep people alive, and that is exactly the kind of positive change he is looking to make.