Ricky Bluthenthal, PhD, challenges assumptions of existing research on people with substance use disorders

For over 30 years, Ricky Bluthenthal, PhD, professor of population and public health sciences at the Keck School of Medicine of USC, has been an advocate for harm reduction initiatives for people who inject drugs (PWID). His research has examined the health outcomes and well-being of this population, especially among racial minorities and low-income populations. “I’ve had an opportunity to understand the economic and racial disparities associated with drug use, and I have also been a part of creating solutions to address the needs of this community,” he says. In 1992, Bluthenthal co-founded the HIV Education and Prevention Project of Alameda County (HEPPAC), a needle exchange program in Oakland.

Since then, he shares that there has been considerable progress. Today, harm reduction is part of federal policy with initiatives which provide housing and easier access to medications for people with opioid use disorder. Similarly, syringe service programs like HEPPAC continue to provide resources to PWID, providing comprehensive services in the areas of HIV recovery, hepatitis C, wound care, and other support services. In 2023, naloxone, a medication used to reverse overdoses, became available over the counter for the first time in stores and online.  Even so, Bluthenthal cautions, “while we witnessed significant changes in the acceptance of these approaches, there has been a real diminution in the wellbeing in this population—materially, socially, and to their health.”

Unhoused Populations and Overdoses

“In the last 10 years, we have witnessed an overdose mortality crisis, a hepatitis C epidemic—mostly driven by PWID, and a nationwide bacterial infection problem, including infections such as infective endocarditis—related to drug use,” he reports. “There is a lot more work that we need to do to address the persistent negative health challenges these populations face,” he stresses.

Notably, PWID have largely become unhoused. “When I started doing research studies in 90s, about a third of the participants were unhoused. In my recent study, this has risen to 80%,” he shared. As a result, Bluthenthal has examined the implications and experiences of being unhoused on this population, specifically encampment sweeps where unhoused persons are forcibly removed from an area. “Our recent findings demonstrate that sweeping encampments make it harder for people to maintain wellbeing—and are basically cruel,” he states. “We’ve also found an association between being displaced and an elevated risk related to HIV, hepatitis C, and also overdose.”

“The impact is devastating,” he acknowledges. Bluthenthal’s research has shown that 70% of people had their food or clothing thrown away. Similarly, naloxone and prescriptions including HIV medication were also disposed. “People need material constancy, privacy, and social support to obtain wellness, and these routine violations of people’s security makes it harder for them to take care of themselves,” he emphasizes.

In his ongoing study, Bluthenthal is assessing the consequences of being displaced related to overdose deaths among unhoused people across different cities. His data shows that moving people around all the time greatly elevates the risk of death both by overdoses and other causes.

Informing Drug-Use Policy

Bluthenthal is also investigating changes in drug use patterns after the legalization of cannabis in California and Colorado. “There was some evidence to suggest that people can use cannabis instead of opiates to manage pain and withdrawal symptoms,” he explains. “Unfortunately, at the same time that cannabis was legalized, fentanyl was introduced into the illicit drug market,” he divulges. “Fentanyl is 50 times more potent that heroin and so the impact of cannabis as a substitution is probably greatly diminished,” he suggests. Changes in drug use patterns underscore the importance of ongoing research among PWID to ensure variations are documented and reflected in the policies geared towards supporting them.

Bluthenthal accomplishes this by sharing his findings formally and informally with his colleagues and policy makers. “I interact with politicians, policymakers, and affected communities so that folks are aware of the potential negative consequences of harmful policies on populations that we all care about,” he reveals. “There are ways we can help people by getting them the right resources that cost less than what we spend on downstream efforts such as sanitation that displaces people,” he insists. Through his qualitative research, Bluthenthal has been proactive in understanding the experiences of PWID. “I’ve not been afraid to change the operating assumptions of existing research to reflect what is happening in the real world,” he concludes.