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Curbing Fentanyl Deaths Should be Guided by Science and Evidence

In a recent JAMA Health Forum viewpoint, Joshua Barocas, MD, writes that science must lead the way in addressing the growing fentanyl public health crisis.

Written by Rachel Sauer on February 17, 2023

In May 2022, the Colorado Legislature passed, and Gov. Jared Polis signed into law, House Bill 1326 – the “fentanyl accountability” bill. Among other actions, the bill introduced stricter criminal penalties for possessing smaller amounts of fentanyl or other drugs laced with fentanyl.

As Joshua Barocas, MD, an associate professor of medicine in the University of Colorado School of Medicine, followed the bill through the legislative process, he knew he had to get even more involved with helping to educate legislators and ensuring that evidence guides policy decisions.

On April 26, 2022, he testified before the Colorado Senate Committee on Judiciary, discussing the need for scientific evidence and treatment.

“This bill, 1326, was initially meant to be a harm reduction, public safety bill, but at the last minute all these increased criminal penalties were introduced to it,” Barocas explains. “We know those don’t work – the science is there; the data are there. I thought it was important to testify on behalf of science and on behalf of public health.”

In a viewpoint recently published in the JAMA Health Forum, Barocas and co-author Cole Jurecka further highlight the imperative of using evidence to inform legislation aimed at curbing fentanyl deaths. The viewpoint is especially timely as the Colorado House Judiciary Committee is scheduled to discuss recently introduced House Bill 1164, the Opioid Harm Reduction Bill, at 1:30 p.m. on Feb. 21.

As currently written, the bill eliminates a provision in last year’s “fentanyl accountability” bill that allows defendants to present evidence that they didn’t know that the drug they have been accused of possessing contained fentanyl.

“Right now, especially with fentanyl, drug use is still incredibly stigmatized,” Barocas says. “Drug use is still considered a moral failing. But it’s not, it's a disease. Unfortunately, many people, including some making policy decisions, view it as a moral failing and not as a disease, so we – scientists – have to say something about the evidence.”

Speaking for the science

As an infectious disease doctor who researches addiction and social determinants of health, Barocas has long been interested in the intersections of criminal justice and infectious disease, with an emphasis on understanding the issues through social justice and health disparities.

Almost 13 years ago, before fentanyl became a public health crisis, Barocas was studying HIV and viral hepatitis. From HIV activism, he recognized that it is sometimes necessary to create a “burning platform” to mobilize action. He also emphasizes that the work must be based on evidence rather than opinion.

“Because we live in an increasingly fragmented world, science doesn’t always speak for itself,” Barocas says. “As researchers, as people who’ve gained a certain expertise or knowledge, we have to be a voice for the science. If we don’t, somebody else is going to present anecdotes as evidence and interpret science how they want it.”

In his JAMA Health Forum viewpoint, Barocas stresses that a significant body of research has demonstrated that intensified drug enforcement laws have done little to deter substance use and may worsen health outcomes. He also notes evidence showing significant racial and economic disparities in how drug penalty laws are enforced.

Focusing on harm reduction

Barocas also emphasizes in the viewpoint that research has shown that medications for opioid use disorder (MOUD) and harm reduction programs have been shown to greatly reduce the negative consequences associated with drug use.

Numerous studies demonstrate that MOUD – including methadone, buprenorphine, and naltrexone – are associated with decreased substance use, reduced cravings, decreased mortality risk, and improved social function and quality of life, he says. Even so, the gap between those who need treatment and those who receive treatment is wide and growing.

Harm reduction efforts, including syringe service programs, overdose education and naloxone distribution, and overdose prevention sites, also reduce drug use risks, according to an expanding body of research.

Barocas has provided his perspective for Colorado House Bill 1202, the Overdose Prevention Center Authorization Bill introduced Feb. 15, which specifies that a city may authorize the operation of an overdose prevention center within the city's jurisdiction for the purpose of saving the lives of people at risk of preventable overdoses.

“This is a longitudinal problem that requires us not to look at short-term data, but for us to look at the arc over time,” Barocas says.

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Joshua Barocas, MD