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“Not surprisingly, you are picking up individuals on the higher risk side of the spectrum,” he added.

Where we are in the drug overdose crisis? Captain Jones described for the assembly the current sate of the overdoes crisis on several levels: –– Dominated by illicit synthetic opioids like fentanyl and analogs but most deaths also involve other drugs. –– Patterns of substances used and how they are being used are changing with rising stimu- lant use and co-use of opioids and stimulants especially injection use. –– Substance use and overdose patterns are tied to changes in supply. Westward expansion of fentanyl and analogs; eastward expansion of methamphetamine and an all-around increase in counterfeit pills containing fentanyl –– Proliferation of highly potent synthetic opioids into an unpredictable drug supply in- creases overdose risk especially among those using multiple substances and those unknow- ingly exposed –– Many missed opportunities for intervention and response. In the criminal justice system, we see the period of reentry as a well-docu- mented time for overdose risk and also where people fall through the cracks. “There is a great opportunity to think about how public health and public safety and criminal justice can work together to think about what’s that infrastructure in the community to support that transition so that people can be successful as they transition back into their communities,” Jones said. Describing some of the challenges posed by stimulants in current context, he told the crowd there still were not FDA-approved medications for cocaine or methamphetamine treatment nor is there a rescue therapy for toxicities like there is for opioids. →

supply or are they a function of changing sub- stance use patterns?” he asked. “What we found in the treatment data is while some may be a supply driven issue, we are also seeing people who are knowingly reporting co-use of opioids and methamphetamine. We found that heroin and/or prescription opioid use at time of ad- mission increased substantially over the 10 years of the study. It is not solely an issue of people be- ing unknowingly exposed to fentanyl. Patterns of use are changing.” Jones then explained how the reverse is true. Heroin users report methamphetamine use as well and there are some disturbing implications from this. “People who report using both heroin and methamphetamine were 35% less likely to have medication treatment as part of their treatment regimen. We already know people using heroin and stimulants are already farther down the risk scale. They are more likely to inject, more likely to have suboptimal treatment outcomes and less likely to receive evidence-based care.” Bringing the discussion back to the audi- ence at hand, he noted the data showed the criminal justice system as a key referral point for treatment. People with both opioid and meth- amphetamine use had an increased chance of criminal justice involvement compared to those who self-referred into treatment or health care provider referred into treatment.

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