Evaluation of the Potential Impact of Expanding Regulated Opioid Access in Seattle Washington

Abstract

The opioid overdose crisis has resulted in over a million deaths in the US since the turn of the millennia. Deaths continue to rise despite concerted efforts to address the opioid crisis through the expansion of treatment options and harm reduction services like naloxone distribution. A primary factor contributing to the rise in death is the volatility of the unregulated drug supply. Since the drug market is unregulated people who use drugs don’t have a way to ensure the potency and quality of their drugs that come from unregulated markets putting them at increased risk of overdose. In the ensuing dissertation, I try to address existing gaps in potential harm reduction strategies, focusing specifically on the implementation of safe supply interventions in Seattle, Washington. Through comprehensive research methodologies, I aim to: 1) determine the population size of people who inject drugs in Seattle, 2) elucidate the preferences and perspectives of people who use opioids, both injection and non-injection, regarding various modalities of accessing opioids, and 3) model the potential impact of implementing certain safe supply scenarios on opioid- related mortality among PWID in Seattle, Washington. Chapter 2 of my dissertation employs several population estimation techniques to ascertain the prevalence of injection drug use in Seattle, Washington. In Chapter 3, I conducted a survey of people who use opioids in Seattle to discern their preferences regarding the procurement of opioids and the perceived impact of different access models on their behaviors and patterns of use. In Chapter 4, I employ microsimulation modeling techniques to forecast the potential outcomes of implementing distinct safe supply programs among people who inject opioids in Seattle. In Chapter 2 of this dissertation, I found a decline in the number of people who inject drugs in Seattle. Respondents in Chapter 3 expressed strong interest in diverse safe supply models, foreseeing substantial improvements in their quality of life, irrespective of potential modifications to their substance use behaviors. Furthermore, Chapter 4 underscored the potential of implementing broadly accessible safe supply interventions in mitigating overdose fatalities among people who inject opioids in Seattle, Washington. The conclusions drawn from this dissertation suggest that implementing safe supply interventions offers a potential promising avenue for reducing overdose fatalities in Seattle. By legalizing and regulating the opioid supply, individuals can access substances in a controlled way with quality assured while potentially promoting healthier use.