Nabarun Dasgupta is on a mission to change how the U.S. prevents overdoses : Shots

When 2024’s provisional overdose data came out earlier this year showing a 27% drop in deaths from 2023 rates, Nabarun Dasgupta felt immense relief.

“I felt like I could exhale for the first time in 20 years,” said Dasgupta, a University of North Carolina epidemiologist who studies street drugs. “When we verified [the data] and felt like this [decline] was real, I think I slept better that night than I had in a long, long, long time.”

Experts say several factors have likely contributed to the steep decline in drug fatalities between 2024 and 2023, including a less deadly drug supply, easier access to addiction treatment and increased distribution of naloxone (also known as Narcan).

Dasgupta’s analysis, published in March, found deaths linked to fentanyl and other street drugs have plunged in many states to levels not seen since 2020.

The work is personal for Dasgupta, he told the health policy news organization Tradeoffs. He started analyzing overdose death data two decades ago when a close friend died of a heroin overdose. As a self-described numbers nerd, Dasgupta hoped digging into the data would help him cope.

“[He] was the first one who really connected me with the human side of the drug problems in the United States,” Dasgupta said of his friend and former colleague, Tony Givens, who died in 2004. “It was just super hard to feel him disappear from my life.”

A chemist in Dasgupta’s lab prepares street drug samples for chemical composition analysis.

Pearson Ripley/UNC

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Pearson Ripley/UNC

What started as an act of self-soothing for Dasgupta quickly became a calling. He’s now one of the country’s leading experts on the epidemiology of street drugs, and his lab’s analysis of overdose trends and the ever-changing drug supply is followed closely by policymakers and journalists.

But Dasgupta told Tradeoffs his most important audience — and inspiration — is the people who have died or could die of an overdose.

“Our primary mission is getting the information back to individuals who use drugs,” Dasgupta said. “Their lives are on the line.”

Below are highlights from Dasgupta’s conversation with Tradeoffs, which has been lightly edited for length and clarity.

Who was Tony Givens? Why was he important to you?

We met in 2002 at Yale, where I was a student, and he was one of the outreach workers. He had a lot of street experience, and I was meant to be learning how to do scientific research in the field with respect for the community.  

Tony was just a huge spirit … super compassionate. I remember the first weekend we were out doing fieldwork. We were in Maine, and I was a student — very hard up for money. He came with me to T.J. Maxx, and it turned out I didn’t have enough money to buy underwear, like on my first day on the job. And Tony put out like a $50 bill and was like, “I got you, man, I got you.” So that’s the kind of guy he was.

There are some people in your life who are more than mentors. They serve the role of a moral compass, and Tony was the first one who really connected me with the human side of the drug problems in the United States.

Can you tell us what happened to Tony?

When I met him, he hadn’t had a drug problem in decades. But he went through some emotional turmoil with a girlfriend and with a close friend. Things spiraled for him, and he decided to end his life. So it was an overdose, but it was an intentional overdose. It was just super hard to feel him disappear from my life.

When you went to the numbers to try to put Tony’s death into context, what happened? And how did that lead you on this path that you’re on still today?

I thought it was going to be an easy question: How many overdose deaths are there in the United States? And at that time — this is 2005 or so — CDC wasn’t putting out those numbers. So what I was directed to, by CDC, are these national files that have one row for each person who has died in the United States — of all causes. And our goal would be to pluck out which ones of those were overdoses.

In order to even download the data, you have to have permissions and software and write code. I figured it out, working on that by myself at night outside of my day job. And when I finally felt confident about it, I looked up and realized, I guess I have all this code and access to data, and I can ask all sorts of other questions of the data. That was how Tony’s death pushed me into trying to understand these numbers and tell a better story with them.

Part of your work is testing the drug supply — understanding the safety of what is being bought and sold on the street. Can you explain how your testing program works?

We get drug samples directly from people who use drugs, along with programs that are providing front-line public health services to keep people alive. Once the samples arrive on campus, we analyze them and figure out exactly what’s in them — every single substance. We put the results on the website so that the people who are using drugs can get the results first.

We can identify if things have been added to it that are dangerous beyond, say, fentanyl or methamphetamine. We’ve identified over 400 unique substances in the drug supply, which gives you a sense of just how unreliable and unpredictable the drug supply is at this current moment.

If you could get any data you want on the behavior of people who use drugs, what would you want to know to help further reduce the estimated 80,000 overdose deaths that we saw last year?

I would want to know why people are still using fentanyl and street opioids. We hear in our field studies — these are like sociological, qualitative assessments — that people are no longer using to get high; they’re using to prevent withdrawal. I think asking, “Why would you still keep using, despite what you know about fentanyl and what you’ve seen happen to your friends?” would unlock an understanding of the barriers that people face to making real changes in their lives.

What you’re saying, I think, is that there is an opportunity for policymakers to access this knowledge on the street and use it to better inform their policymaking?

Yes, theoretically there is that opportunity. But our primary mission is getting the information back to individuals who use drugs. Their lives are on the line. We, as scientists and policymakers, are not affected in the same way. So we try to get the information back to the community first, let them do with the information what they need to do to protect themselves. And then we can find patterns that can inform policy and science. But that’s really a secondary aim.

What about someone who says the best way to help people on the street is to create better policy? That going one by one with people is not efficient when the problem is still so enormous?

Over the last 50 years, U.S. drug policy has not done a particularly good job. Overdoses have reached historically high levels. So when we throw up our hands and say, “This is too big of a problem to personalize and to solve,” I think we’re doing ourselves a disservice. It might be time to move away from a national drug policy and have localized, regional or even city-level drug policy that fits what is happening in the drug supply.

You almost have a free-market approach in your perspective: Consumers need to know what is in the supply at an individual level, and we need to trust that consumers are, more often than not, going to make smart, rational choices.

Absolutely. Drugs are a free market. They’re very lightly regulated, and there’s a lot of untapped potential by looking at people who use drugs as consumers — to empower them to make changes on a grassroots level, in a way that top-down law enforcement efforts cannot reach, and have not in the last 20, 30, 40, 50 years of drug policy in the United States. The drug supply has gotten more intense, more dangerous. We need to do something that will break that cycle.

When I’ve talked to you in the past, you are upbeat, often sunny. At the same time, I’m quite confident this work has taken a real toll on you. How do you describe that toll?

On good days, I try to harness it as the reason why I have to keep going. And other days, I’ll just disappear myself into paperwork tasks and doing expense reports, to not have to directly engage with death. My cellphone contains millions of death records, and it’s like a weight in my pocket being carried around, just feeling that level of loss.

People will send us drug samples, and they’re in these white cardboard boxes. And oftentimes on top of it, we’ll see handwritten notes and little figures drawn. People saying, “Thank you,” or “Your service helped someone save their life.” Having those types of notes every week really makes a difference. Just the personal feeling of “OK, this isn’t just data collection. This is actually doing something in service.”

In a sentence, what would Tony say about the work that you’ve done?

“You’ve done good, but you have a lot to learn.” It’d be delivered with a laugh and a pat on the back and a hug, and probably some tears in his eyes for being proud of me.

I know there are a lot more people who are going to die, but, I think maybe, just maybe, for the first time in two decades, I feel like, OK, we’re headed in the right direction.

Dan Gorenstein is executive editor and Ryan Levi is a reporter for Tradeoffs, a nonprofit news organization that reports on health care’s toughest choices. You can sign up for Tradeoffs’ weekly newsletter to get the latest stories in your inbox each Thursday morning.