Interview with Dr. Nabarun Dasgupta, Scientist at Epidemico and the University of North Carolina at Chapel Hill
By Tessie Castillo
If you work on overdose prevention in North Carolina, chances are you’ve heard the name Nabarun Dasgupta. From helping to found one of those most successful overdose prevention programs in the nation to delving into research on black market prices for prescription drugs, Nab has his fingers in all pieces of the pie. But he’s more than just a scientist or epidemiologist. Dasgupta may enjoy combing through matrices of poisoning data, but he also uses his findings to launch programs and interventions so that statistics are not just numbers on a spreadsheet, but life-saving tools to prevent overdose.
TC: Describe your work in overdose prevention in North Carolina over the years.
ND: I was interested in prescription opioids and overdose before I came to North Carolina, but when I got here I felt a personal and professional responsibility to help solve the problem. Being a nerdy epidemiologist, I downloaded the state overdose data, figured out where the hot spots were for overdose deaths and got involved with local folks in those areas to work on the issues.
I helped start Project Lazarus and worked five years pro bono on data analysis, writing grants, presentations and designing interventions with Fred Brason and Kay Sanford. I also served on the Board for the North Carolina Harm Reduction Coalition (NCHRC) and tried to steer them towards work on overdose prevention. When I joined the Board, most of our focus was on HIV and hepatitis. I’m glad to see now that NCHRC has adopted overdose prevention in a strong way and has awesome staff to implement it.
TC: What is your latest research on prescription drugs?
ND: We looked at street prices to see if the unregulated black market for prescription drugs could predict the molecular potency of different types of painkillers. Usually when new drugs are being developed the companies run clinical trials to determine which medicines have higher or lower abuse potential. In the trials the researchers ask participants, usually experienced drug users, how much they would pay for certain drugs and compile the quantitative data to determine abuse potential. For our research, we wanted to see if the price differences between drugs on the black market would mirror the results of clinical trials and if they could predict drug potency.
We collected the price data from StreetRx, part of the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS) System [Link: radars.org] nationwide collection of prescription data, and found that the unregulated street market predicts molecular potency almost perfectly. In other words, the strongest prescription opioids sell for the highest price on the black market, and the weakest drugs cost the least.
Check out the study: http://www.jmir.org/...
TC: How can information on black market prices be used to inform drug policy?
ND: Right now the pharmaceutical industry is developing new formulations of drugs that are difficult to tamper with and crush, so the fundamental question is, are the new tamper-resistant products more or less abusable than the projects already on the market? One way to gage this is by looking at street prices. For example, when the new tamper-resistant OxyContin was created, it sold for less on the street market than the old, crushable formulation, which demonstrates that it has less potential for abuse. Doctors might also use information on street desirability to make decisions about which drugs to prescribe to patients.
TC: Couldn’t the creation of more tamper-resistant drugs merely divert abuse to substitutes?
ND: Absolutely, especially in the context of the widespread availability of heroin and other prescription opioids. No one tamper-resistant product is going to solve the broad societal problems of addiction and opioid abuse. Past experience in the United Kingdom and Australia shows that damage and death can result from the introduction of abuse-resistant formulations if they are not rolled out within the public health and harm reduction model.
TC: So what can be done to ensure that tamper-resistant formulations don’t result in drug diversion and more overdose fatalities?
ND: Access to drug treatment and harm reduction services will ultimately reduce the tremendous toll that these medications take on our society. People have been trying to make less abusive forms of opioids since morphine was first isolated. Heroin was once considered less abusable than morphine; codeine less abusable than heroin; methamphetamine less abusable than amphetamine, etc. We have a history of failure trying to come up with a solution to the drug problem without addressing the social issues that contribute to it.
TC: You recently defended a PhD dissertation at UNC. What was it about and how does it relate to your other work?
ND: Basically I discovered that when it comes to opioids and analgesics, there are some serious flaws in studies that are cited to set clinical guidelines on the maximum limit of how much opioid should be prescribed for pain. The policies don’t take into account the co-prescription of benzodiazepines. The risk of overdose is much higher if opioids are prescribed with benzodiazepines, but conversely, if benzos are not being prescribed, we can treat people with higher doses of opioids, for example for cancer.
TC: What’s in the future for you?
ND: I have a paper coming out on the effectiveness of prescription monitoring programs at preventing overdose deaths funded by the Robert Wood Johnson Foundation. They appear to no be sufficient to stop overdose deaths on their own, in fact overdose deaths actually increase after prescription monitoring programs are implemented. That paper should come out in September. After that, I don’t know. Just preparing to be a Dad!