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Police drug market disruptions and number of drug sources among people who use drugs in San Francisco

Year: 2026

Type: article

Abstract: Overdose mortality in the United States remains high. Law enforcement-based efforts to suppress the illicit drug supply may destabilize markets, prompting people who use drugs to seek alternative sources with uncertain potency, a response that may elevate overdose risk. We tested whether geographical exposure to drug distribution enforcement is associated with number of drug sources among people who use drugs. We analyzed cross-sectional survey data from 716 people who use drugs in San Francisco, California (September 2023–September 2024) recruited using targeted sampling. The main outcome was number of self-reported drug sources in past 3 months. We geocoded each participant’s prior night location and spatially linked it to drug distribution arrests within 250 m over the same 3-month period, categorizing geographical exposure into tertiles (low, moderate, high). Negative binomial regression with robust standard errors estimated associations between being located near drug distribution arrest and number of drug sources, adjusting for age, race, gender, and housing status. Participants had a median age of 43 years (IQR: 35–53) and 65% reported housing instability. The median number of drug sources in past 3 months was 9.5 (IQR: 4–20). Relative to low-exposure group, people who use drugs in moderate and high exposure geographical areas reported significantly more drug sources (aIRR = 1.78, 95% CI: 1.45–2.18; aIRR = 1.66, 95% CI: 1.35–2.05, respectively), with a significant dose–response trend ( p < 0.001). Older age was associated with fewer sources (aIRR per 10 years = 0.91, 95% CI: 0.83–0.99), as was identifying as Black or African American (aIRR = 0.65, 95% CI: 0.54–0.79). People with greater geographical exposure to drug distribution arrests reported significantly more drug sources, suggesting that law enforcement-based drug market disruptions may produce consequences that destabilize local drug markets and increase overdose risk, running counter to their stated public safety aims. These findings contribute empirical evidence to an emerging literature linking supply-disruption enforcement to changes in adaptations in drug access following market disruption. Alongside expansion of evidence-based public health strategies, including medications for opioid use disorder and naloxone distribution, enforcement practices warrant careful reconsideration by policymakers and public health practitioners. Not applicable.

Source: Health & Justice

DOI: 10.1186/s40352-026-00450-z

Authors: Jamie Humphrey, Bradley Ray, Megan Lindstrom, Carine Megerian, Barrot Lambdin, Alex Kral

Institution: RTI International

Language: English

Topic: HIV, Drug Use, Sexual Risk

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Peace, justice, and strong institutions

Open Access status: gold

Estimated APC paid: $1,790