Connecting Street Drugs and Science with Dr. Nabarun Dasgupta

This week, we had the pleasure of interviewing one of TIME Magazine's 100 most influential people: Dr. Nabarun Dasgupta, Senior Scientist at the University of North Carolina. He runs the Street Drug Lab, an innovative lab that is on the front lines of harm reduction work here in North Carolina and across the country. As we celebrate the first decrease in overdose deaths in 5 years, we know that his work and the work of harm reductionists everywhere have played a major role in that decrease.

What is Connections by APNC?

Welcome to "Connections," the podcast that bridges the gap between addiction and mental health through the prism of policy and practice. Join the hosts, Morgan Coyner and Sara Howe, as they unravel the intricate connections within the world of addiction. In each episode, they dive deep into the intersection of prevention and recovery.

Welcome to Connections, the podcast from addiction professionals of North Carolina, where we explore the nuances of addiction and mental health through the lens of policy and practice. We're your hosts, Sarah Howe and Morgan Koiner, and we're here to help you see how it all connects. Today we're coming to you live from the APNC Spring Conference where we can bring you different guests to talk about several different critical topics in our field.
We're really excited to be able to bring somebody today that is, I'm going to say, a Time Person of the Year. We're super excited about this. Morgan, why don't you introduce our guest? I would love to. We, today on the podcast, we have Dr. Naberun Dasgupta. He is a street drug scientist and activist at the University of North Carolina with two decades of experience in overdose prevention.
And he's the co founder of Remedy Alliance for the People. [00:01:00] Welcome Dr. Dasgupta. Thanks for having me. Honored to be here. Of course. Well, we're just thankful you could join us for a little chat. So I want to jump right into some of the work that you're doing. You work in the UNC street drug lab, and I'm interested, what is it?
Why was it started and what are we learning from that lab in real time? Sure. So the, so right now we don't find out what's in street drugs until it's too late when people are either dead or they're arrested. And so if we really care about prevention, if we really care about redemption, then we want to be able to understand what's in the street drug supply before people get, get harmed from those substances.
And, um, and when we were. Uh, as we watch the, the problems with opioids in the United States, uh, switch from prescription opioids to. To illicitly manufactured opioids. It was [00:02:00] clear to us that the traditional systems we had looking at prescriptions and other ways to count how much opioids there are. We're not going to be sufficient.
So, about 4 years ago, we started planning and thinking about really, like, We would be able to monitor the street drug supply so we can have a better understanding of what's in the in street drugs while the supply changes, uh, during, you know, in the post COVID period. So it was early during COVID when I was at like a drive through where we were doing, where it was still like COVID PCR tests.
And there was like a kit where there was a nasal swab. And I remember shoving that up my nose and being like, Hey, if we can do this and like drop this swab in a vial and send it off to a lab and get results for COVID, like, why can't we do that with street drugs? And the answer is we can. And that's the paradigm that we built our system off.
So what are you finding today in the trends in your [00:03:00] lab? What are we seeing right now? Well, we get samples from about 35 states, uh, heavy concentration in North Carolina. I think we have about 35 programs in North Carolina sending us samples, uh, and these are harm reduction programs. There are drug user unions, they are EMS and clinics, health departments.
And hospitals. And so, um, we get, you know, we get an intentionally very mixed set of substances and we see, you know, the substances we usually get. I think we've tested about over 5000 samples already. And so a lot of fentanyl, a lot of methamphetamine, um, and, you know, psychedelics. Benzo's cocaine and crack samples.
It's kind of the full mix of what's out there. Um, but what's, you know, thinking about cocaine, I mean, sorry, thinking about meth and fence at all, which are 2 of the most common types of samples. Um, The pure, like what's in when people say that they're taking meth in North Carolina, [00:04:00] chances are that it's only math that's going into their bodies when they say they're taking fentanyl, it's usually a mix of substances like up to 17 different substances that can easily be found in any given fentanyl sub sample.
17 all at once. And so, I mean, overall we've detected about 260 unique substances in the street drug supply. Um, and that seems high at first. And then our colleagues who have been doing this for like a decade in Canada, and they're like, Oh, you're just starting out. It's actually more like 700 substances.
So we expect that to go up. And we can name like seven of them, right? Right. Okay. Well, that was, I was actually going to ask you and now it almost seems like a foolish question with 200 to 700, but what we've just seen actually recently is the legislature in Raleigh is looking to make gas station heroin, TNF teen, a controlled substance.
So again, one of [00:05:00] 200 or 700 as a case may be. But are you starting to see a proliferance of TNF team? Um, we see, yeah, we've definitely had TNF team samples. Um, I mean, the thing to understand about our trends is that we're not, like people send us samples often when things go wrong, when things are weird, right?
And so that's a bias that we know, and it's a bias that we welcome. Because our goal, this is not a research study. This is science and service. We are a public service of a public university. And our goal is to like, let this technology be available to people in their local context so they can. Figure out so that they can answer the questions that are important to them in their local context without having it having to have it be like a formal research study.
Oftentimes folks will programs will use the kits and won't even tell us like the results of studies. So 1 example is there was a group in Nevada who there was a street myth going around that whether you could test, um, [00:06:00] uh, fentanyl, whether you could identify fentanyl or xylosine using a black light. And, you know, chemically we were like, maybe, I don't know.
I don't know. It didn't make sense or, but maybe, but they sent pictures that were like, you know, vials and powders for us in different colors. And we're like, okay. So they sent us the samples and we did it in a masked fashion. So we didn't know which colors or which ones fluoresce. And we gave them the results of what was in each of those samples.
And they were able to answer that question for them in that moment. But they didn't tell us the results. So I don't actually know if StreetKick blacklights, right? But it doesn't, but that's kind of like part of how we design the system is to give up some of this control and power that researchers and universities have and let the folks on the ground kind of define the question, answer the question, and we're providing the service.
So how do you find partners to provide you? The samples. Um, I mean, we have about [00:07:00] 160 programs around the country or so. Um, it's largely been word of mouth. We haven't advertised or anything. Um, within our listeners are interested and aren't a partner. Is there a way they can connect with you? Yeah, absolutely.
Um, street safe dot supply is the website. If you're in North Carolina, thanks to the General Assembly. This service is free. Um, outside of North Carolina, there's a, um, like 20 fee per sample. Uh, so, uh, but we are, yeah, so within North Carolina, we're happy to test. And it's been really fascinating to see how different groups in North Carolina have used the results and, and answered their local questions.
So there was a group in Western North Carolina that started noticing that after there were made like busts of local meth producers, you know, that the meth supply would get more variable and nasty, and they wanted to see if that was actually the case. So they did like some baseline, um, drug sampling, and then there was a big bust in that [00:08:00] county.
And they sampled afterwards and saw that the number of impurities and the number of toxins in meth went from being like zero all the way up Up to like, you know, constantly in every sample. Um, and so that was something that they could message to their participants and say, like, look, like the mess up.
This is what's happened to the mess. Supply. These are the kinds of side effects. You can be expecting, like, here's how you can use less or find better ways to do what you need to do. So, um, We had a group, uh, very recently, um, this is an ongoing investigation, like with, uh, an EMS in eastern North Carolina, uh, where there was a spate of, um, fatal overdoses and, uh, in one part of the county, kind of very clustered and they suspect there is a new.
Something, there's something different about those particular samples. So as they were responding to fatal and non fatal overdose calls, uh, they were collecting the [00:09:00] samples, providing, and then we're testing them right now. And they're going to provide those results back to the individuals who are in the community and as well as to local MAT clinic.
Um, and they've done this a few times now. So they have like a catalog of the different stamp bags, like kind of what each packaging for different, um, types of heroin or fentanyl look like and what's the composition and they've been able to provide that, um, back to the community that they serve. That's so cool.
I love it. It's just kind of like. Pure science, you know, without a lot of the strings that come attached when you, um, like you said, add a lot of the control pieces in. So I love that. I'm curious. As harm reduction has sort of recently entered into this more public moment, it's, I have found at least anecdotally for myself, the argument, um, [00:10:00] because I, I think it's still very controversial and sort of the mainstream and, and the argument for harm reduction that I typically hear is like, well, we're saving lives and they're people.
And I think those are super important arguments because they're very true. But I'm curious from sort of the science side, like, what evidence do we have or what evidence, um, not evidence, data, are we finding that kind of supports that, that these sort of harm reduction practices, Are actually effective, um, and, and should be supported.
Mm hmm. Yeah, I mean, I think you're, you're spot on, like, harm reduction is common sense and having done this work in North Carolina for 20 years and having seen the way, you know, we've been talking about harm reduction in like. Rural conservative or just, you know, poor parts of North Carolina for a long time and all along.
It's like, has never really [00:11:00] felt that controversial to me on the ground. Um, it seems like there's heated policy discourse, but I think. We're blessed in North Carolina to have a lot of pragmatic folks who are in positions of authority in local government, local, you know, uh, health coalitions. And, uh, we've had very little pushback.
And so I think. You know, filling in the science, there's science like in general is like very reductionist, right? Like, we try to isolate the impact of 1 thing at a time. What we find is like the, that it's rarely like 1 harm reduction intervention at a time that has like a huge impact on any given indicator.
What we do find is that collectively, when you put the theory and the tools and the practice together, And fund it well, then you see the appreciable declines in overdose, um, and infections and all sorts of other, uh, health, [00:12:00] uh, complications as well as crime. But I mean, part of it has to be drug treatment, and I think that's, um, an essential part of the continuum.
And there has to be services for people who want to be abstinent and stay abstinent. So I don't, I think oftentimes we define harm reduction. Just narrowly by the tools like syringe exchange or, uh, naloxone distribution and these things. But, um, what's really powerful is the compassion that comes out of it and the collective effort that happens when we stop dehumanizing people for their choices.
Yeah, I've, I've listened to an interview did, and you just with such. And love for the people who you get to serve because at the end of the day, like, I, I don't know. I think sometimes I, we can get so bogged down in research or numbers or data that we forget about the human people and it seems like you've really been able to keep [00:13:00] the humanity at the center of your work, even in the way you set up the street drug lab.
Like, it just seems like that's a really Yeah. Crucial part of this work for you and that you haven't lost that. Yeah. I mean, I'll take it as a compliment, but disagree that it's like something that I've kept in there. It's something I feel like I've had to evolve into. I mean, doing this for 20 years, right.
It's like, you see these damn numbers go up and up and up. And there's like, there's only so much information you can get from. From those, from watching that graph climb year after year. Um, and we see like interventions and we see a lot of changes that have happened on the ground for the better. And those numbers still keep going up and that's frustrating.
Um, and I think there's also this like collective grief that's happening where like 42 percent of adults know someone who's died of an overdose in the United States, like that's a lot of missing holes in our, in our families, in our communities, and so, um, I [00:14:00] think. My realization, I guess, over the last few years has been like, I'm not going to be able to change these big numbers in my youth.
Maybe I thought I could, but, um, if I can do something that helps that feel that empowers people, empowers communities to show some more love and help people kind of get to where they want to be, then I'm going to have to say that's good enough because, uh, it's depressing trying to make the big number go down all the time.
But I think you make a good point, though, about the holes in our families and the holes in our communities. And oftentimes, as we know, policy catches up to what we're seeing on the ground in communities. And so, in this field, we have been seeing this for a while. Unfortunately, what has happened, like you said, that collective grief, and what our policy makers are starting to see when constituents call.
When there's a grieving parent, family member that really [00:15:00] talks about what has happened and it takes away, um, disbelief. This can't happen in my community. You're talking numerous communities in North Carolina that you're getting calls from. Those from, you know, a rural city, you know, from each corner of the state, and we're still seeing it.
So it takes, it takes that away, that disbelief that it can't happen here. Yes, that's right. It is happening. It's happening. A lot of places. I think it's also interesting to look at the places where the overdose numbers are not so bad, and there's definitely pockets in the, in the state and definitely in the country to where the overdose numbers are not as high as we would expect on a per capita basis.
And, um. Kind of, there's like, like a lot of simplistic narratives that like poverty and overdose go together, but in some of like the poor counties, especially like in the northeastern part of our state, the overdose numbers aren't always as high as we would expect. Um, there's other [00:16:00] kind of pockets where there might be protective factors happening and other things that are happening societally that.
We don't pay attention to because we're in this like mode of risk factor epidemiology, right? Where we're always looking for what makes things explaining why things are the way they are. Um, I think, you know, a really good example of this is looking at What happens with substance use after natural disasters.
So like hurricanes and other things like that. And if you look at the data from, uh, after hurricanes, Katrina and Rita, and in Louisiana and the Gulf coast, you saw this huge increase in substance use across, uh, across different substances, but really accentuated in folks of lower socioeconomic strata, when you look at.
Hurricanes look at substance use in Puerto Rico, for example, after hurricanes, you don't see that same level of substance increase and, um, very, like very rigorous and long [00:17:00] term studies have shown that a lot of that has to do with the social and family networks on the island being more protective against, um, you know, and helping people cope with grief and more.
Personal familial ways than and helping avoid some of the slide into substance use, especially alcohol. You're, um, you're speaking to a kid who was who got into this field because. You're speaking my heart, but it's something we don't always talk about, right? Is that end of the continuum? And really, I mean, when you said that there's different pockets, it immediately made me think, well, we need to talk to those communities and find out what are those protective factors?
What are they doing? And how can we replicate that across the state? So it just reminds us that Prevention is possible and it does work. It does necessary. And sometimes it may be unintentional, right? I mean, there are the things that prevent a community from having an entrenched substance use problem may be unintentional.
The same types of preventative things that [00:18:00] happen, you know, to prevent obesity or some other health problem or some other housing problem. So, um, yeah, you know, there's like the famous line from, I forget which Russian novel, but it's like every, every happy family is the same. Every miserable family has its own way of being miserable.
Yes. Tolstoy. There we go. Right. Yes. Well, I think we would be remiss before we leave. If we did not. Both mention and ask about I mean you were named to the time 100 list, which is so cool And it's it's actually how I learned about your work and I called Sarah and I was like, oh my gosh This guy's from North Carolina.
We have to talk to him He's doing such cool work and just in fairness. She was looking at the Taylor Swift part of the time magazine
Um, I'm just, I have a wide range of interest, but what has that been like for you? I mean, I imagine you didn't, uh, get a PhD to, to get like such broad global recognition or [00:19:00] maybe even expect it. Like, what has that been like, um, For you in this work to, to get that kind of recognition and what have you seen come from it?
Um, so I'll say my 10 year old son is a big fan of Taylor Swift. So no negative things will be said with him. Um, I think, I mean, it's been really humbling and. This was not the intention to get recognition. It's always been, you know, it's really goes back to science and service. I mean, we can be re like, I don't call myself a researcher anymore because research is often extractive.
And all I want to do is, um, in whatever time I have left on earth, just like use the scientific skills I have to, you know, make things a little bit better for other people, and I find that oftentimes the best thing we can do is give people tools to make the best decisions with their health and step out of the way.
And, um, the recognition is really nice and it's flattering and they threw a really fun party in New York and there [00:20:00] was a red carpet and, um, it's a once in a lifetime thing. But, uh, but it's not something I think about every day. I mean, for the, what I do think though. For those of us who've been doing this work for a long time for something like time to recognize the critical importance of what you're doing and that science, you're right.
It's great to have the recognition and have the right part of that makes volumes to the evolution of our field to have these conversations where before we were talking amongst ourselves. And now that recognition that says, look, look what we're doing. Look at what's happening at UNC and what this means.
It goes back to the whole Yeah. Families, right? You know, probably said, like, we got to point out someone doing work in this field and people are like, you're right, because all of us know what it's like. That's right. And I think it's been, it's been the collective effort of so many [00:21:00] people in this field who had been doing this work for longer than me, for sure.
And, you know, and behind like our lab, behind our, behind remedy Alliance, there's amazing people who make it work, who would have been just as good a poster person as me for that ward. But it's like, you know, just, it's sad to see. That older generation of pioneers in the field slowly pass away, retire, uh, move on to other things.
But, um, it kind of reminds me that my, that this is not a job I can do forever. The accumulated grief is just too much. And so, um, I also appreciate that there's a lot of sudden death that happens even outside of drugs. And so, you know, it's just doing what you can while you're here and, uh, hoping that helps somebody.
Well, we're really excited, one, that you have been so generous with your time to talk to us, but to have you in our backyard, um, be able to point to UNC for many [00:22:00] things and our wonderful institutions across North Carolina, but to have this, dare I say, you know, groundbreaking in the sense that what you're doing makes perfect sense.
In one sense, you could say that's not groundbreaking, but for our field and I think for communities to want that information. That's really what makes it groundbreaking is that they want to know about, and they're starting to have these dialogues with you. You said 35 States. I think you're in, right? I mean, it's not just here.
It's, it's a movement that is growing. So we're, we're, we're. incredibly appreciative of what you're doing. Um, on behalf of these families that don't have a voice and that makes a difference. North Carolina is a great place to do this work. Like I said, like the pragmatic feel of folks on the ground here is different from the other states we work in.
And it's just been, you know, yeah, follow the common sense and help people. That's great. Well, thank you so much again for your time and for the work that you do. You have you have a friend in us for sure [00:23:00] So if there's ever anything we can do to support just let us know you have a couple fans. Yeah We will certainly be checking in.
Thank you. I appreciate it. Thanks for having me out. Awesome You