The police opioid seizure temporal risk (POSTeR) model of increased exposure to fatal overdose

Abstract

CONTEXT: Police seizures of illicit opioids remain a dominant strategy for addressing problematic substance use and overdose in the United States and throughout the world, yet qualitative accounts and quantitative analyses exhibit positive associations between police opioid seizures and ensuing risk of fatal overdose at the local level of individual incidents. Since these associations run counter to the commonly held belief that removing potent illicit substances from the community is protective of overdose, a causal model is needed to demonstrate this association and convey the overdose risks that follow from police opioid seizures.

METHODS: Leveraging well-established biological and psychological outcomes of opioid use disorder and opioid supply interruption, our analysis presents the Police Opioid Seizure Temporal Risk (POSTeR) Model, an individual-level casual model that begins at the point of opioid dependence, introduces an interruption to an individual's supply of opioids as the result of a police drug seizure, and presents the physical and behavioral outcomes that increase the ensuing temporal risk of fatal overdose.

RESULTS: The aftermath of a police opioid seizure can increase a person's risk of fatal overdose. The urgent need to prevent or reduce acute opioid withdrawal symptoms leads people to seek a replacement supply, while reduced opioid tolerance resulting from post-seizure involuntary abstinence combines with the uncertain potency of a replacement supply of illicit opioids to significantly increase the difficulty of administering a safe but effective dose. In the face of these hazards, people in withdrawal often have a reduced aversion to risk, prompting them to consume this uncertain dose in a manner that increases their exposure to overdose.

CONCLUSIONS: Strategies that emphasize police opioid seizures as an acceptable way to reduce the prevalence of illicit drugs in a community without accounting for the elevated risk of fatal overdose that results can worsen one of the most significant problems they are meant to address.