Through her work with the TestRI research project, a comprehensive two-year study funded by the Foundation for Opioid Response Efforts (FORE) as part of the People, Place & Health Collective at Brown’s School of Public Health, Assistant Professor of Epidemiology and PSTC associate Alexandra B. Collins and her colleagues worked to illuminate the structural causes of overdose risk within the state of Rhode Island by tracking changes in the local drug supply. 

While the fentanyl-related overdose rate has increased dramatically in Rhode Island over the past decade, little community and state level data has been collected to track these specific changes in the drug supply. “Typically, surveillance data on drug supplies is from drug seizure data or fatal overdose data, which doesn’t give us a good understanding of what people are experiencing day to day in the supplies,” says Professor Collins. “That is where having community drug checking services and working with community partners is really critical to better understand how people are using drugs, what they’re experiencing, and how they are managing changes.” 

In order to help bridge this gap, Collins and her team collaborated with several Rhode Island community partners and clinicians to collect comprehensive local drug data and then communicate these findings to local harm reduction organizations and individuals who use drugs. Specifically, the project partnered with the Rhode Island Department of Health and the Rhode Island Hospital toxicology lab, where fellow mPI Dr. Rachel Wightman conducted all toxicology testing for the project. 

Collins and her colleagues published their findings from these efforts in an August 2023 paper, entitled “Comprehensive testing and rapid dissemination of local drug supply surveillance data in Rhode Island.” Within their report, they noted that high rates of xylazine had been detected alongside fentanyl in the statewide drug supply, a surprising finding that can help organizations and individuals better understand the causal factors driving local overdose risk. 

“Researchers and policymakers have to work alongside community organizations and people who use drugs to really ensure the work and policies are attentive to the needs of people who use drugs and are grounded in harm reduction principles,” says Collins.

However, she also stresses the need for community and governmental leaders to think about the broader social harms that may impact overdose risk. “All of these efforts have to also be paired with funding for housing and broader service needs to support people,” she says. “When we fail to address the social and structural drivers of overdose risk (e.g., policing, socio-economic marginalization, criminalization of poverty, toxic drug supply) we reinforce harm and overdose risk for people who use drugs.”