Why Drug Dealers Are an Under-Utilized Anti-Overdose Resource

    Last year, a man in his 20s attending Electric Forest, a Michigan music festival, began to cry after discovering that the cocaine he had been selling tested positive for fentanylthe potent opioid significantly driving the overdose crisis.

    “Today, for the first time, unknown to me, I had something that could really, really harm someone,” Jake* confessed to a camera he used to record his reaction. “And I had no fucking idea.”

    The batch that caused his distress was not from his usual source, though. Jake told Filter that he had “resorted to finding them from someone that I have known for years prior, who had always had quality stuff.”

    He was shocked to learn, after using a Bunk Police fentanyl test provided by the checking company’s founder, Adam Auctor, that his coke was not what he thought.  This, he said, particularly “impacted me because I was dedicated to bringing quality substances to my friends and family.”

    After filming the video, Jake took action. “I immediately stopped offering that product, and even took a monetary loss on it,” he recalled. “Upon the test that confirmed fent, I approached and threatened my guy to stop the shit he was dealing.”

    According to Jake, his dealer agreedand even decided to confront the supplier above him. “He drove two hours from the festival as it was still going on to talk to [the original dealer].”

    Jake’s reaction was not unusual. Veiled by criminalization and racist stereotypes, many people who sell drugs are concerned by the fentanyl-involved overdose crisis in North American drug user communitiesand are taking steps to keep their customers safe. But there’s nuanced debate over how harm reductionistsin spaces from syringe service programs to safe consumption sites to drug user unionsshould be engaging this constituency.

    Dealers’ Untapped Harm Reduction Potential

    Harm reduction is, as its name suggests, about reducing all harms associated with drug use—and the harm reductionists from across the country that Filter spoke with unanimously affirmed the key role of drug sellers in achieving this.

    Working with drug sellers to supply them with testing resources and naloxone for distribution is an obvious win,” Eliza Wheeler, the overdose response strategist for the Harm Reduction Coalition, told Filter. “They have the most contact with folks who are using drugs than anyone.”

    Specifically, sellers could be a critical entry point for getting harm reduction supplies into the hands of people who may not otherwise be able to make it to a centralized service site.

    “I think connecting with sellers and engaging them in harm reduction has particularly great potential in rural or remote areas,” said Alyssa Stryker, a former criminal justice reform manager at the Drug Policy Alliance, who worked on the organization’s “Rethinking the Drug Dealer” project. “They are obviously getting their drugs from somewhere. If they could be getting drugs and harm reduction support at the same time, we might be able to reach totally new users with harm reduction who just can’t access it right now.”

    This strategy has been verified as effective by the Iowa Harm Reduction Coalition, which financially supports people around the rural state to act as “secondary distributors” of naloxone and other supplies. According to Executive Director Sarah Ziegenhorn, the secondary distributors’ “first stop is the drug sellers in their community, because they recognize that those individuals have the greatest likelihood to make an impact in reaching individuals in a community, and can effectively saturate a community with Narcan and drug testing supplies given their connections to drug users.”

    Jake agrees that sellers play a key role in keeping users safe, particularly with regards to drug checking. “If you don’t do it, then you shouldn’t assume anyone else will. If you don’t fully test your substances you are putting yourself and your friends at risk,” he said.

    And for Louise Vincent, founder and executive director of Urban Survivors Union, failing to work with drug dealers is nonsensical: “It’s like dealing with the pill crisis and not talking to the doctors.”

    The fact that people who sell drugs often also use them underlines the importance of engaging this community. Seven in 10 people incarcerated in state prisons for drug trafficking were also using drugs around the time of the offense, according to a US Bureau of Justice survey. Additionally, around 40 percent of people who disclosed having sold drugs also reported that they met the criteria for a substance use disorder.

    Why This Isn’t Happening Enough

    Despite some harm reductionists’ support for engaging people who sell drugs, Geoff Bardwell, a postdoctoral research fellow at University of British Columbia’s Centre on Substance Use, noted that stigmatization and criminalization are barriers to overt programming.

    Bardwell thinks it’s reasonable to believe that there is “hesitation for public health officials to say that they want to engage dealers.” He added, “There’s this false dichotomy that dealers are bad people, and that people who use are good and are just victimized.”

    The tendency to shy away from connecting with dealers is based in the punitive logic of the drug war, not the evidence of science, say advocates. For Vincent, who is based in Greensboro, North Carolina, the rigid distinction between users and dealers, and public health’s tendency to exclude the latter, is highly racialized and perpetuates anti-Black racism.

    “Here in the South, it’s a race issue. We started with the ‘good drug user’ versus ‘bad drug user.’ And we keep it going down,” said Vincent.

    In the United States, people of color have long been imagined to be pushing drugs on innocent white people. In the 19th century, immigrant Chinese men were feared to be seducing white women with opium, while the early 20th century saw a panic around Mexican-Americans allegedly spreading marijuana. Today, China and Mexico continue to be blamed for the influx of fentanyl into the US heroin supply.

    All the while, Black people are nearly conflated with people who sell drugs: 76 percent of federal prisoners convicted under trafficking laws are Black or Latino, yet studies have shown that white people are more likely to report having sold controlled substances.

    In some local jurisdictions, racist outcomes are even more extreme. For example, in McHenry County, Illinois, where black people constitute under 2 percent of the population, over 35 percent (four out of 11 between 2013 and 2016) of drug-induced homicide cases brought by prosecutors targeted Black people.

    Sellers’ persistent racist criminalization stands in the way of officials working with them to benefit public health. “Typically reforms that reduce the degree of criminalization of use and possession do not include any trafficking offenses at all,” wrote Stryker, referencing Good Samaritan laws that protect people from possession chargesthough not trafficking oneswhen they contact law enforcement to report a potential overdose.

    People who sell drugs are well aware that a target has been placed on their back. As a result, they often do not trust service providers, regardless of whether the providers are interested in working with them. “They are skeptical,” wrote Ziegenhorn, “that any organization could work with drug users and do so in a way that does not threaten their freedom from incarceration.”

    Strategizing Engagement with Sellers

    Amid these barriers, harm reductionists who acknowledge the critical role of sellers within drug-using communities are left with the question of how best to engage them.

    To this end, they are considering approaches that range from discreet messaging to open outreach.

    “From our point of view, as people working for the government, we are doing ‘Don’t ask, Don’t tell,’ Dr. Mark Lysyshyn, a medical health officer at Vancouver Coastal Health (VCH) in British Columbia, told Filter. By this, he means that VCH can’t simply advertise its provision of drug checkingitself illegalto an already-criminalized demographic.

    For Wheeler, too, broadcasting outreach efforts to the general public isn’t necessarily worth the risk. “It’s a difficult issue because being candid about that can also get our programs shut downwhich can and has happened,” she wrote. “Harm reduction programs are always under attack for ‘attracting drug dealers,’ and while we have a nuanced understanding of this, I think the reason that programs are not as forthcoming and explicit about this is because we are always under attack and threatened.”

    In the face of this, Lysyshyn’s program is, in part intentionally, operated to be conducive for use by people who make and sell drugs. “All our drug checking services are anonymous,” he said. “We don’t ask any questions about who is using them. We do that so they don’t worry about police entrapment.” 

    And he believes dealers are using the services. VHC’s spectrometer regularly shows samples that are nearly 50 percent fentanyl. Lysyshyn interprets this as an indicator of dealers’ utilization of services, since “We believe a good majority of those samples are before they are cut.”

    Additionally, VCH and BC Centre for Disease Control (BCCDC) launched a take-home drug checking study on May 14. Lysyshyn says that this initiative, which involves distribution of five fentanyl strips per day, allowed more people who sell and make drugs to utilize checking. Although the strips provide less information than the building-bound spectrometer, they can help overcome a significant barrier faced by dealers: entering a space that puts them in potential legal jeopardy.

    “I don’t think [sellers would] go into some government building, take out all their dope, and then put it on [the drug checking technology],” stated Participant 17, an Indigenous woman in her mid-20s who uses drugs, in Bardwell’s study. Another participant, a white man in his late 30s, added, “They’d want to make sure their privacy is protected. Nobody wants to go to jail.” Lysyshyn believes the program lends itself to seller-utilization because they “don’t need to test on site. They can take them and test the drug wherever.”

    Alternatively, Wheeler has found that people utilizing syringe exchanges in the Bay Area can act as proxies for their sellers. “Folks who are accessing services are bringing supplies and info to their dealers for distribution upon their request. Like ‘Hey, my dealer wants a bunch of test strips and Narcan, can I bring some to them?’” she said. “So that’s another way that indirect sort of outreach happens, when people who are selling are not coming to access services themselves.”

    VCH also reaches sellers by employing people who have experience in drug user communities. “We are working with peer supporters with lived experience. In their conversations, they can encourage drug dealers to come,” said Lysyshyn.

    Ziegenhorn noted that “it’s almost impossible to connect with drug sellers unless you have a personal connection with them and have a contact that can vouch for you as an individual who is trustworthy.” That’s why peer workers are effective: “There is some trust there. Peer communication is a promising way to get them engaged,” said Lysyshyn.

    Walking on eggshells, the public health establishment faces limits when it comes to building truly inclusive harm reduction work. It is “unrealistic for the majority of public health professionals to be able to establish relationships with drug sellers,” argued Ziegenhorn. “These are relationships that are often only able to be developed by people who purchase drugs or who are in close relationships with people who purchase drugs.”

    That, perhaps, is how and why grassroots harm reductionists are taking bold action.

    “I don’t see the kind of movement in the state,” said Vincent. But she does know that grassroots organizations—and even solo individuals—are already doing this work. “I do see community resilience.”

    A Personal Mission to Reach Dealers

    Harm reduction legend Tino Fuentes is one example. Formerly co-director of the syringe exchange and naloxone programs at St. Ann’s Corner of Harm Reduction in the South Bronx, Fuentes resigned in 2016 to pursue lone-wolf harm reduction, distributing fentanyl test strips for checking purposes. He told Filter that, among other things, it was difficult to freely serve people selling drugs while acting under the auspices of a social services organization. “It wouldn’t look good for the agency, and it could jeopardize the agency. But for me, it’s different. I work for myself. The only person I’m putting at risk is myself.”

    For him, the legal risks are worthwhile given the stakes of people using a potent, opaque supply. His convictions were confirmed by a recent interaction with, Jessica*, a street-based seller in Manhattan. “After two or three weeks of buying [from] her, every time I tested her drugs, it came up positive for fentanyl and benzos. I explained to her it’s dangerous with the fentanyl as it is. But with a mix of fentanyl and benzos, it’s really dangerous.”

    As a result, Jessica “said she would talk to her people. I started testing her drugs again, and the benzos had been removed.” Fuentes sees this as a major win—one that wouldn’t have been possible without making a concerted effort to engage with people selling drugs.

    Through his one-on-one outreach efforts, Fuentes hopes to provide checking to people higher in the supply chain who otherwise remain out of reach to by-the-books organizations. “Unless I could get to a higher person, it won’t really make a difference.” For him, it’s potentially the most effective way to spread awareness, and tangibly intervene in the drug supply.

    Making this happen requires a sustained effort. “It was hard to get to dealers,” noted Fuentez. “You have to create a relationship.” That is probably easier when you are not connected with a formal organization. Fuentes’s strategy was simply to buy from themboth for testing purposes and for his own useand continue to build trust from there. Nonprofit organizations and government agencies don’t have the legal latitude to do that, he recognizes. But for him, it’s a personal calling.

    “I believe in asking for forgiveness, instead of permission. That’s the best way I’ve found,” said Fuentes. “I’m going to do what I have to do. If I get caught and I go before a judge, I’ll say, ‘People are dying.'”

    *Name has been changed.


    Photograph by Centre for Disease Control of British Columbia via Twitter

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