Exploring Space-Time Interactions in Fatal Opioid Overdoses.
Geographical Analysis
Rey, Sergio, Elijah Knaap, Alejandra Cabral & Jennifer Syvertsen
2025
The emergence of fentanyl in a stimulant landscape: Un/intentional use, social relations, and developing communities of care.
International Journal of Drug Policy
Syvertsen, Jennifer, Alejandra Cabral, Elijah Knaap, Sergio Rey & Robin A. Pollini, 2025
"Solidarity"
Contribution to special section, “Pretty Words: Critical perspectives on community-engaged research,” Annals of Anthropological Practice, doi.org/10.1111/napa.70005
Jennifer Syvertsen 2025
Panel presentation at the 2025 annual meeting of the Society for Applied Anthropology in Portland, OR:
“Revitalizing Community Care Amidst the Fourth Wave of Overdose: Applied Anthropology in Times of Crisis”
Overdose & Harm Reduction:
Research Project
Overarching Goals of the Research Project
Overdose is a significant public health issue in our communities, as more than one million people have died from a drug overdose since 1999. The overall goal of this project is to learn about opioid overdose to inform prevention and educational efforts. A broader goal is to center compassionate approaches to address overdose and change harmful narratives of drug use by uplifting harm reduction in our communities.
Study Findings
What kinds of information did we gather for our study?
From November 2022 – November 2023, we conducted 195 surveys with people who use drugs. Surveys covered socio-demographics, geographic questions about where people lived and spent time, drug use histories, overdose, including personal experiences and responding to others, use of harm reduction and healthcare services, general health and wellbeing, and law enforcement encounters.
We need new ways to resist the War on Drugs that center social justice and compassionately address drug use in our communities. In this hands-on workshop, an anthropologist and a community artist will offer a historical grounding in harm reduction as a grassroots movement and practical set of strategies to address drug-related harms. Based on our shared learning about the subversive role of art in harm reduction education and community organizing, we will engage in our own art-making as a methodology to revitalize the contributions of creativity and collaboration in improving community health. No artistic training is required!
Revitalizing community health through the art of harm reduction.
Topics we learned about in our surveys:
Sociodemographics
Age, race, ethnicity, gender, education, housing status, job income, insurance, partnership status, sexual orientation, children, pets.
Geosocial
Places where the person lives and spends time, birth place, length of time in Riverside County, transportation.
Drug Use
Drugs use history, fentanyl use (Intentional and unintentional), drug behaviors, market, locations, policies, laws.
Overdose
Experience and witness opioid overdose, narcan use, overarming, pet overdose.
Harm Reduction
Harm reduction program access & use, secondary distribution, harm reduction behaviors.
Health & Wellbeing
Physical & mental health, resilience, structural vulnerability.
Law Enforcement
Experiences with Law Enforcements.
Final Section
Other topics related to overdose, future study participation, participant input.
Who participated
in our
survey?
Of 195 individuals surveyed:
31%
Identified as Female
43
Average Age
Sexual Orientation
86%
Heterosexual
39%
In a partnership of 3 months+
Racialized Groups
60%
Non-Hispanic Black: 12%
Hispanic/Latinx: 28%
Multiracial: 17%, Other: 3%
86%
High School or above education
73%
Are unhoused
78%
Born outside of Riverside County
68%
Have Kids
46%
Have Pets
Who participated
in our
survey?
Of 195 individuals surveyed:
What drugs have people used?
The Art of
Harm Reduction
Zine
What drugs have people
used?
60%
Reported opioid use
40%
exclusively use stimulants, primarily methamphetamine
Cannabis
95%
Tobacco
78%
Meth
98%
Heroin
73%
Fentanyl
58%
Prescription opioids (no RX)
64%
Meth
46%
Powder Cocaine
18%
Heroin
6%
Prescription opioids (no RX)
7%
Average age of first drug use: 17 (8-38)
Yes
67%
Average age of first injection drug use: 24 (range: 11-52)
81%
reported family members ever using drugs (not including alc or cannabis)
What were some of the important things we learned in our study?
Overdose
Overdose
Have you ever experienced an opioid overdose?
-
Yes: 48%
When was the last time?
-
61% reported that their last overdose was within the last year
During your last overdose
-
Did EMS give you naloxone? 25%
-
Last time you overdosed did anyone other than EMS give you naloxone? Yes: 44%
-
Who?
-
Friend 60%
-
Partner 25%
-
-
-
Did the police come? Yes: 13%
-
Did the ambulance come? 36%
-
Did you go to the ER? 30%
Why is this important?
-
Many people in the community are responding to overdose
-
there are low rates of follow-up care in healthcare facilities
-
Important to saturate naloxone into the communities who needs it
-
Community-based overdose aftercare is important; could we develop an aftercare program that is non-coercive and harm reduction-based?
What factors are significantly associated with experiencing an opioid overdose?
-
People reporting overdose are more likely to report histories of opioid use, including heroin, fentanyl, and injection drug use
-
People reporting overdose are more likely to have a steady partner
Why is this important?
-
Fentanyl is a risk for overdose - we know this drug can be risky, but scare tactics and criminalization do not help; we should promote harm reduction strategies, including overdose prevention education, carrying naloxone, never using alone, using fentanyl test strips, and establishing a community drug checking program
-
People told us the stress of being in a relationship could be a explanatory factor for drug use resulting in overdose; we should consider the social context of drug use
Have you ever witnessed an opioid overdose?
-
Yes: 87%
In our qualitative interviews, we found that:
-
Some community members have become “super responders” - they have regularly revived others in the community with naloxone
-
“... talking about this [overdose] used to be traumatizing, but now it’s normal; it’s happening all the time. I used to get really worked up but now I know to stay calm… I’ve never let anyone die.” - participant
Why is this important?
-
Community response to overdose has saved countless lives
-
Try to remain calm and act right away to help
-
Learn how to respond to an overdose from the National Harm Reduction Coalition
-
Contact Inland Empire Harm Reduction or another agency for naloxone and educational materials about overdose prevention
During the last overdose you witnessed did you call 911?
-
Only 23% called 911
-
Why not?
-
8% - Did not have a phone
-
9% - Afraid to call
-
9% - Afraid to be arrested
-
11% - Thought police would treat them badly
-
22% - Thought they could revive/wake them themselves
-
19% - Afraid police would show up
-
33% - Someone else already called
-
-
Almost half (48%) of the reasons provided for not calling 911 during an overdose are related to fear of law enforcement.
Open-ended answers about (not) calling 911 after this question from survey:
-
“First off we don't call the cops second off someone else was already doing it but they take too long and I already worked on her without narcan cause I didn't have any on me and I was able to bring her back”.
-
“The person came out of the overdose gradually after someone else administered Narcan, so it was not needed”.
-
“didn't want to be the snitch that gets others in trouble, lots of drugs in that area”.
-
“with this group, we are not going to call cops/ambulance unless have problems and not responding; takes too long, mistrust and they wont even respond in the Riverbottom; had to walk him to get narcan at camp, did CPR beforehand, on walk, he passed out and gave him CPR, then narcan”.
-
“We don't call the cops around here it's like the street rules so we try our best to save a life but if it don't work then we tried and someone calls and we dip out”.
-
“The person jumped up after administering narcan, so we believed we did not need to call the police”.
Why is this important?
-
People do not call 911 for fear of the police responding → can we reconsider police response to overdose?
-
Many overdose experiences are not represented in “official” statistics → need for community support
Policing
Can pets overdose?
Policing
Contact with police was quite common among those surveyed:
Ever stopped: Yes 95.1%
Ever arrested: Yes 92.4%
Have you ever been verbally, abused, insulted, or harassed? Yes 67%
Have you ever been physically assaulted? Yes 43%
Have you ever been sexually assaulted? Yes 5%
Fentanyl: Fact or Fiction?
Fentanyl is widely available in the community, but you cannot overdose simply by touching it or being in proximity to it!
Fear-based campaigns about fentanyl are ineffective and stigmatize people, as one woman in our study told us:
"Yeah, Fentanyl is terrifying and stuff. But really?... But whatever happens if someone around you does it and you don't know what to do then? Because now, you're just going to shun that person and be like, "Oh, I can't believe you did that." But you're not helping anybody with a loved one who does it already. You're just trying to scare people off of it, which is just causing more discrimination and more hatred towards people who are already using it."
Is fentanyl being added to the drug supply?
Do you believe fentanyl is being added to drug supply?
-
84% said Yes; however, we really do not know if and to the extent this may be happening
-
Read our paper about the emergence of fentanyl here!
Why is that important?
-
Take precautions with unknown substances - go slow and don’t use alone
-
Support harm reduction! This includes naloxone, overdose education and response training, fentanyl testing strips, and pipe distribution to cut down on sharing
-
People using stimulants reported negative health effects from unintentional fentanyl use, such as overdosing or getting sick → we need to tailor harm reduction programing for stimulant use (pipe distribution, overdose training and encouragement to carry naloxone even if you do not use opioids - maybe someone else in your community will need it)
-
The extent to which fentanyl is in the drug supply is unknown; building a community drug checking program can help us better understand the ever-changing drug supply
*** Coming soon! UCR is partnering with Inland Empire Harm Reduction to create a community drug checking program ****
What is Harm Reduction?
“Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”
Based on our research, people in our community value harm reduction and tell us it helps people and has saved lives!
-
Have you ever heard of harm reduction?
-
Yes 91%
-
-
Have you ever accessed harm reduction supplies?
-
Yes 76%
-
-
Have you ever accessed supplies from IEHR?
-
77%
-
What are all the different types of supplies you’ve gotten from IEHR?
90%
Safer Smoking Kits (pipes)
88%
Naloxone
74%
Syringe Kits
68%
Lunch/Food
67%
Snorting Kits
60%
Hygiene Kits
57%
Wound Care
51%
Fentanyl Test Strips
50%
Reproductive Health Supplies
45%
COVID Mitigation Stuff
38%
Booty Bumping Kits
32%
Clothes
29%
Blankets
27%
Tents
27%
Referrals to other services
Other
From open response:
Fire safety stuff, pet food, bus passes, needle disposal
Based on our research, people in our community value harm reduction and tell us it helps people and has saved lives!
-
Have you ever accessed Narcan/naloxone?
-
Ever 85%
-
Do you currently have access to naloxone?
-
84%
-
-
-
Have you ever tested your drugs with fentanyl test strips?
-
Yes 76%
-
What does the Community think about Harm Reduction?
Quotes from survey data about IEHR:
-“What they do is pretty awesome because not that many people care - they take time and it's cool”
-“It’s good to have them, they've saved a lot of lives with the stuff they give out”
-“They are amazing - the staff is great, non judgmental and accepting, willing to help anyone in all situations”
-“They are great. Thank u for your guys services you don't know how many lives are saved”
-“I've always had a good relationship with them”
Quotes from qualitative key stakeholder interviews:
“…. it's not just about learning how to be safe when you use drugs. That's not just what happens with harm reduction. What happens with harm reduction is this community and this support system that I've never had before, and this acceptance, radical acceptance of who people are. And I've never had that before…. [it] just changed everything for me, changed how I use substances, changed the way I talk about substances, just changed everything.”
- Harm Reductionist
“We can't talk about or reduce stigma until we talk about decriminalizing drugs and drug use.”
- Public Health Worker
“My personal belief is every single person should have Narcan, just like every single person should be trained in CPR. They're both life saving things. I carry Narcan. You never know when you need it. You never know when you're going to need CPR. So every single person should be trained in CPR.”
- Public Health Worker
“I think what makes harm reduction so successful is that the people on the ground are the most knowledgeable”
- Harm Reductionist
Why is this important?
-
Harm reduction is so much more than giving out naloxone – it is an ethos for how operate in the world and treat people; it is about community care
-
People are accessing all kinds of supplies and services from our local harm reduction organization!
-
There is pretty good coverage of naloxone in the community, and this is helping with overdose response.
-
The relationship-building and non-judgmental care provided by harm reductionists is critically important to reaching community members who need services
-
Can pets overdose?
Pets eat things they shouldn’t - including drugs. Accidents can happen and pets can overdose and get sick from opioids.
-
In our survey 32% have witnessed a pet overdose on opioids.
-
Of those who reported witnessing a pet overdose, 44% administered naloxone to the pet.
-
Why is this important?
-
Keep your drugs safely stored and away from pets
-
Stay with your pet if you think they have gotten into drugs and monitor them
-
Naloxone works to reverse opioid overdose in pets
-
See this printable zine for more information about responding to a pet overdose
See our Publications and Presentations
Can pets overdose?
Pets eat things they shouldn’t - including drugs. Accidents can happen and pets can overdose and get sick from opioids.
-
In our survey, 32% have witnessed a pet overdose on opioids.
-
Of those who reported witnessing a pet overdose, 44% administered naloxone to the pet.
-
Why is this important?
-
Keep your drugs safely stored and away from pets
-
Stay with your pet if you think they have gotten into drugs and monitor them
-
Naloxone works to reverse opioid overdose in pets
-
See this printable zine for more information about responding to a pet overdose
Funded with the generous support of NIH grant: R21DA054611.
The views expressed on this website do not necessarily reflect the funding agency.