Saba Rouhani
Saba Rouhani
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Assistant Professor of Epidemiology
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Professional overview
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Dr. Saba Rouhani is an Assistant Professor in the Department of Epidemiology at GPH. She conducts research in social epidemiology, policy evaluation, and overdose prevention.
Prior to joining NYU Dr. Rouhani worked as research faculty in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health. She also completed a fellowship funded by the National Institutes of Health/National Institute on Drug Abuse. Her research has been published in the International Journal of Drug Policy, Drug and Alcohol Dependence, the Journal of Urban Health, and the American Journal of Public Health and Preventive Medicine.
Dr. Rouhani received her PhD in global disease epidemiology and control from the Johns Hopkins Bloomberg School of Public Health. She holds an MSc in the control of infectious diseases from the London School of Hygiene and Tropical Medicine, and a BSc in medical microbiology from the University of Edinburgh.
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Education
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PhD Global Disease Epidemiology & Control, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAMS Control of Infectious Diseases, The London School of Hygiene & Tropical Medicine, London, United KingdomBS Medical Microbiology, University of Edinburgh, Edinburgh, United Kingdom
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Honors and awards
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Drug Dependency Epidemiology Training (T32) Fellowship, National Institute of Drug Abuse, National Institutes of Health (2018)The R. Bradley Sack Family Scholarship Award, Johns Hopkins Bloomberg School of Public Health (2016)Global Health Established Field Placement Scholarship, Johns Hopkins Bloomberg School of Public Health (2014)Save the Children Program Management Award, Save the Children International (2012)Royal Society of Tropical Medicine and Hygiene Award for Best Poster Presentation of Research in Progress (2012)
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Publications
Publications
Beliefs of US chiefs of police about substance use disorder, fentanyl exposure, overdose response, and use of discretion: results from a national survey
AbstractBailey, A., Andraka-Christou, B., Rouhani, S., Clark, M. H., Atkins, D., & Del Pozo, B. (n.d.).Publication year
2025Journal title
Health and JusticeVolume
13Issue
1AbstractBackground: To inform the feasibility and acceptability of evidence-informed police practices related to substance use, addiction, and overdose, we sought to better understand how US police chiefs perceive substance use and related policing practices. Methods: A national sample of randomly selected US police chiefs (N = 276) completed a 37-item survey about substance use and policing. Nine items assessed chiefs’ perceptions of: officers’ discretion in making arrests, effectiveness of overdose responses, risks of fentanyl exposure, de-escalation practices, harmful drugs in their community, and illicitly-obtained buprenorphine. Data were analyzed with descriptive statistics and exploratory ordinal logistic regressions. Results: Most chiefs (72.5%) agreed that arrest for any nonviolent misdemeanor was at the discretion of their officers, and they overwhelmingly (94.9%) trusted their officers to make the right arrest decision. The majority of chiefs (87.7%) felt their officers could effectively respond to an opioid overdose, and 83.7% reported their officers carried naloxone on patrol. Chiefs in the Northeast were significantly less likely to be confident in their officers’ ability to respond to a methamphetamine overdose than chiefs in the West. Most (90.0%) were receptive to implementing methamphetamine de-escalation strategies (i.e., techniques to resolve crises short of force). Almost all chiefs (91.2%) agreed with the inaccurate statement that fentanyl exposure at a drug overdose scene could harm officers. Conclusions: Police chiefs express interest in several types of evidence-based public health approaches to policing. Critically, there is a need to curtail fentanyl misinformation and to improve officer knowledge about medications for treating opioid use disorder.Disparities in willingness to call the police in a 2023 survey of US adults: Implications for alternative crisis response programs
AbstractRouhani, S., Machavariani, E., McSorley, A. M., Todd, T. L., & Purtle, J. (n.d.).Publication year
2025Journal title
Preventive MedicineVolume
198AbstractObjective: To estimate willingness to call the police in an emergency among US adults to inform policies addressing emergency response and help-seeking. Methods: We utilized cross-sectional data from a web-based 2023 Survey of Racism and Health of (N = 5059) adults in 12 Northeastern and Mid-Atlantic states and D.C. We estimated odds of willingness to call the police as a function of gender, race/ethnicity, and lifetime diagnosis with a behavioral health (substance use or mental health) condition using unadjusted and adjusted logistic regression. Results: Most of the sample (80 %) reported willingness to call the police in an emergency. Dds were observed among Black (aOR 0.33; 95 % CI 0.27–0.41), American Indian/Native American (aOR 0.43; 95 % CI 0.27, 0.70), and Multiracial (aOR 0.36; 95 % CI 0.25–0.52) compared to White respondents, and those with behavioral health diagnoses (aOR 0.73; 95 % CI 0.61, 0.88). Women (aOR 1.23; 95 % CI 1.05, 1.43) and older adults (Age 55+: aOR 4.62; 95 % CI 3.70, 5.80) reported higher willingness to call the police. Conclusions: Findings highlight subpopulations for whom the police may not be a viable source of emergency response, particularly individuals who are racially minoritized and/or have behavioral health conditions. This has implications for alternative response programs which rely on 911 dispatch to triage calls and highlights a need for targeted messaging and alternative mechanisms to call for service in communities with police mistrust.Examining the association between psychological resilience and chronic versus discrete stressors among individuals who use opioids in Baltimore, Maryland
AbstractSisson, L. N., Tomko, C., Rouhani, S., & Sherman, S. G. (n.d.).Publication year
2025Journal title
Drug and Alcohol ReviewVolume
44Issue
1Page(s)
288-297AbstractIntroduction: Psychological resilience has emerged as a key construct of interest in the study of substance use. However, very few studies have examined resilience among individuals who are actively using drugs. Furthermore, many studies of psychological resilience have focused on individual-level factors. This study addresses the call for a more ‘ecological’ approach to the study of resilience by exploring how socio-structural vulnerabilities may shape individuals' assessment of their own ability to cope. Methods: The Peer Harm Reduction of Maryland Outreach Tiered Evaluation study conducted a cross-sectional survey of people who used opioids in Baltimore, Maryland, USA (n = 565). Resilience was measured using the 10-item Connor-Davidson Resilience Scale. We used linear regression to examine the association between resilience and stressors commonly encountered by individuals who use drugs, including both chronic, enduring stressors (e.g., homelessness, food insecurity) and discrete, event-based stressors (e.g., overdose, arrest). Results: We observed a negative relationship between self-reported resilience and chronic stressors. Specifically, individuals who reported experiencing three (β = −4.08; p = 0.002) or four (β = −4.67; p = 0.008) types of chronic stress had significantly lower resilience scores. Additionally, we found that an unmet need for mental health treatment was associated with reduced resilience (β = −1.74; p = 0.040) and greater educational attainment was associated with increased resilience (β = 2.13; p = 0.005). Discussion and Conclusions: Overlapping experiences of socio-structural vulnerability, as well as access to mental health care, may influence how individuals who use drugs evaluate their own resilience. Interventions that seek to promote the resilience of this population should focus on addressing structural drivers of marginalisation and barriers to mental health treatment.Harms associated with injecting in public spaces: a global systematic review and meta-analysis
AbstractKhezri, M., Kimball, S., McKnight, C., Rouhani, S., Bunting, A. M., Karamouzian, M., Ompad, D. C., & Des Jarlais, D. (n.d.).Publication year
2025Journal title
International Journal of Drug PolicyVolume
140AbstractBackground: Despite increasing backlash against harm reduction efforts and the need to understand the risk environments encountered by people who inject drugs (PWID), a quantitative systematic review on public injecting and associated health and drug-related outcomes is lacking. We aimed to summarize the global evidence on the prevalence and harms associated with injecting in public spaces. Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus, Global Health, and Web of Science from inception to March 21, 2024. We pooled data from included studies using random-effects meta-analyses to quantify the associations between recent (i.e., current or within the last year) public injecting and associated outcomes. Public injecting was defined as injecting in public or semi-public spaces, including streets, parks, and abandoned buildings. Risk of bias was assessed using the Joanna Briggs Institute's critical appraisal tool. Results: Of the 6144 initial records, 84 studies were eligible for inclusion. The pooled prevalence of recent public injecting was 48.85 % (95 % confidence intervals [CI] 43.87, 53.85). Public injecting was associated with increased odds of recent non-fatal overdose (odds ratio [OR] 2.51, 95 % CI 2.01, 3.13), HCV infection (OR 1.55, 95 % CI 1.18, 2.02), recent needle/syringe sharing (OR 2.41, 95 % CI 1.97, 2.94), recent sex work (OR 1.75, 95 % CI 1.03, 2.97), recent incarceration (OR 2.10, 95 % CI 1.78, 2.47), and recent unstable housing/homelessness (OR 4.23, 95 % CI 3.17, 5.65). Public injecting showed a statistically non-significant association with HIV infection (OR 1.41, 95 % CI 0.80, 2.46). Public injecting was also associated with a higher willingness to use supervised injection facilities (OR 2.66, 95 % CI 1.86, 3.80). Conclusion: Public injecting is prevalent among PWID and associated with various adverse drug- and health-related outcomes, highlighting the need for increased access to safe injection spaces. Findings support developing interventions to reduce harms from public injecting, such as addressing structural risks from law enforcement, expanding naloxone programs, and establishing overdose prevention centers. Housing interventions, in particular, could serve as an effective upstream strategy to reduce public injecting and related harms.Implementation of Overdose Prevention in Maryland: Implications for Resource Allocation, Program Scale-Up, and Evaluation
AbstractTomko, C., Rouhani, S., Johnson, R. M., Susukida, R., Byregowda, H., Parnham, T., Schneider, K. E., Gibson, M., Heath, T., Rickard, R., Boyd, C. E., & Park, J. N. (n.d.).Publication year
2025Journal title
Health promotion practiceVolume
26Issue
2Page(s)
332-341AbstractOverdose mortality in the United States continues to climb, with Maryland being one of the hardest hit states. We summarized implementation of overdose prevention and response programs in Maryland and identified associations between opioid overdose deaths by jurisdiction in 2019 and implementation of overdose programs by 2021. Data on program implementation are from Maryland’s Opioid Operational Command Center (OOCC) Program Inventory. OOCC coordinates the state’s response to overdose, and their Program Inventory tracks implementation of 145 programs across 12 domains (e.g., public health, education, and judiciary), including 10 programs designed to broaden naloxone access. The level of program implementation was dichotomized as substantial implementation versus other levels (i.e., partial, planned, and none). We estimated associations between per capita opioid overdose deaths and substantial implementation of: all 145 programs in the Inventory, programs within each of 12 domains, and 10 naloxone programs. Data on program implementation and overdose mortality are summarized at the jurisdiction level. Across jurisdictions, the median proportion of programs with substantial implementation was 51% across all programs and 70% among naloxone programs. Overdose mortality was associated with subsequent substantial implementation of programs within the public health domain (p =.04), but not in the other 11 domains. We did not find evidence that per capita overdose deaths in 2019 spurred overdose program implementation by 2021, with the exception of public health programs. The OOCC Program Inventory is a novel way to track implementation across jurisdictions. Findings can inform the implementation and evaluation of overdose programs in other jurisdictions across the United States.Navigating US illicit drug market volatility: Harm reduction strategies employed by people who inject drugs
AbstractWiniker, A. K., Sisson, L. N., Schneider, K. E., Rouhani, S., Martin, E. M., Nestadt, D. F., Silberzahn, B. E., Zhang, L., Footer, K., & Sherman, S. G. (n.d.).Publication year
2025Journal title
Health Promotion InternationalVolume
40Issue
4AbstractThe US illicit drug market is increasingly unreliable, with new and often harmful adulterants contributing to overdose risk among people who use drugs. In this context, it is crucial to examine whether people who inject drugs (PWID) are aware of these changes and if so, how they are adapting to inform harm reduction interventions and programs. In-depth interviews were conducted with 23 PWID between July 2022 and January 2023. Interviews explored participants' substance use behaviors and perspectives on harm reduction interventions. A combined deductive and inductive thematic analysis was conducted to identify emergent themes. This analysis focuses upon participants' discussions around drug market activity/changes, drug-related harms, drug use risk perceptions, and harm reduction strategies. Participants demonstrated awareness of the increasing volatility and risk associated with illicit substance use. They reported engaging a range of strategies to reduce the risk of these harms, motivated by individual-level cognitions and behaviors, as well as external-level interpersonal relationship dynamics. These findings highlight that perceived risk translates to behavior change amid a changing market, suggesting the need for universal drug testing access, responsive health education/harm reduction programming, peer-based interventions, and structural changes to reduce barriers to harm reduction behavior change.Racial Discrimination and Substance Use: Results from a 2023 Survey of Racism and Public Health in the United States
AbstractRouhani, S., Bather, J. R., Cuevas, A. G., Omari, I., Harris, A., McSorley, A. M., Rhodes-Bratton, B., & Goodman, M. S. (n.d.).Publication year
2025Journal title
Substance Use and MisuseAbstractBackground: Racial/ethnic disparities in substance use outcomes continue to widen in the US. Despite increasing evidence of the myriad ways that racism impacts health, this has not been extensively studied with respect to substance use outcomes. The current study explores the association between self-reported exposure to racial discrimination across the life course and substance use disorders among US adults. Methods: We analyzed data from a web-based cross-sectional survey of adults in 13 states and Puerto Rico in March–April 2023. Exposure to racism in childhood, adolescence, adulthood, and within the past year was measured on a cumulative life course scale (range 0–4). Analyses were restricted to respondents identifying as White, Black, and/or Hispanic (N = 4,338). Multivariable models estimated the adjusted association between cumulative racial discrimination and lifetime substance use disorder (SUD) diagnosis. Among those with exposure to racial discrimination (N = 1,895), we explored correlates of coping with any form of discrimination by using substances. Results: We detected evidence of an interaction between race/ethnicity and cumulative racial discrimination, with a higher predicted probability of SUD associated with discrimination among those racialized as Black (non-Hispanic Black and Afro-Hispanic). There was evidence of a dose-response relationship between cumulative racial discrimination and the likelihood of coping through increased substance use. Conclusions: Experiences of racial discrimination over the life course may contribute to disparities in substance use outcomes. More research is needed to disentangle multiple, overlapping forms of discrimination faced by people who use different substances and how they may explain variation in outcomes among them.Specialized Mental Health Crisis Response Activities Within US Law Enforcement Agencies
AbstractLindenfeld, Z., Mauri, A. I., Rouhani, S., & Willison, C. E. (n.d.).Publication year
2025Journal title
Community mental health journalAbstractObjective: This study examines the prevalence of specialized police responses to persons experiencing a mental health crisis across U.S. law enforcement agencies and explores whether organizational and community factors are associated with their presence. Methods: This study used 2020 data from a nationally representative survey of over 2,500 law enforcement agencies. The primary outcomes included whether agencies implemented one of four responses: (1) designated unit, (2) designated personnel, (3) addressed mental health without designated unit or personnel, or (4) did not address. Logistic regression models assessed factors associated with each response type. Results: Over half (51.0%, n = 1,349) of agencies addressed mental health but lacked designated units or personnel, while 6.9% (n = 183) did not specifically address mental health. Larger agencies, agencies located in urban areas, as well as those with external partnerships, and a higher number of use of force complaints were significantly more likely to designate a unit or personnel. Conclusions: Fewer than half of law enforcement agencies have responses for mental health crises. Further research is needed to identify barriers and facilitators to adopting specialized responses, particularly among rural and under-resourced agencies.Substance Checking Outreach and PrEP Engagement (SCOPE) Study: protocol for a non-randomised clinical trial in Baltimore, Maryland USA
AbstractSchneider, K. E., Nestadt, D. F., Martin, E. M., Morris, M., Rouhani, S., Weir, B. W., & Sherman, S. G. (n.d.).Publication year
2025Journal title
BMJ openVolume
15Issue
7AbstractIntroduction As the opioid crisis continues, people who use drugs (PWUD) experience a disproportionate burden of both HIV and overdose, driven by increased injection-related HIV outbreaks and an opaque and rapidly evolving drug market, respectively. Pre-exposure prophylaxis (PrEP) for HIV and point-of-care drug checking services are underused yet potentially impactful interventions to address the harms of the opioid crisis. Implementing such interventions using known strategies to enhance client engagement and reduce access barriers, such as street outreach, mobile services and peer navigation, can optimise intervention and maximise their impact. Methods and analysis The Substance Checking Outreach and PrEP Engagement (SCOPE) Study is a non-randomised clinical trial evaluating the impact of the Check It intervention, a mobile community PrEP and drug checking intervention in Baltimore, Maryland, USA. SCOPE will recruit a cohort of 500 PWUD at risk for HIV through street-based recruitment methods. Cohort members will be followed semi-annually for 18 months. The primary study outcomes are engagement with the PrEP continuum of care and the number of non-fatal overdoses. We will use both random effects models and marginal structural models to estimate the effects of Check It on participant engagement on the PrEP continuum and the number of non-fatal overdoses over time. Ethics and dissemination Study procedures have been approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Risks to participants are low, with the most serious risk being potential data confidentiality breaches. This risk was minimised through the use of secure data storage platforms with limited user access. Study findings will be disseminated through peer-reviewed manuscripts, academic presentations, and reports and fact sheets designed for lay audiences. Trial registration number This study was registered with clinicaltrials.gov (study ID: NCT05977881; Protocol ID: 00017498).“All You Can Do is What You Know to Do”: Naloxone Knowledge and Uncertainty Among People Who Use Drugs in Maryland amid a Volatile Drug Market
AbstractSisson, L. N., Winiker, A. K., Triece, T., Rousch, R. S., Rouhani, S., Owczarzak, J., Sherman, S. G., & Schneider, K. E. (n.d.).Publication year
2025Journal title
Substance Use and MisuseVolume
60Issue
8Page(s)
1164-1172AbstractCommunity-based distribution of naloxone has continued to serve as an important strategy in combatting the U.S. opioid overdose crisis. People who use drugs are first responders in this crisis, administering and disseminating knowledge about naloxone among their social networks. However, it is unclear how knowledge of naloxone evolves over time and across individuals, especially amid a volatile, unregulated drug market. Objectives: We conducted 22 qualitative interviews with people who use drugs in rural, suburban, and urban regions of Maryland. Interviews focused on respondents’ experiences witnessing and experiencing overdose, reversing overdoses with naloxone, and sources of uncertainty in overdose response. Results: Participants demonstrated high willingness and capacity to respond to overdose using naloxone. However, limited technical knowledge about naloxone contributed to riskier overdose reversal strategies, especially among individuals who had not received formal training. Non-naloxone reversal strategies, such as rescue breathing, were not widely used by participants. Finally, perceived volatility within local drug markets, specifically fentanyl analogues and xylazine, undermined participants’ confidence in the effectiveness of naloxone. Conclusion: People who use drugs serve an important role in community-based overdose reversal. Leveraging their experiential knowledge of overdose with technical knowledge of naloxone is foundational to effective community-based naloxone dissemination. Harm reduction programs should ensure that educational materials describe technical aspects of overdose response in ways that are intuitive to the experiences of people who use drugs, as well as ensure materials are responsive to an evolving drug supply.Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities
AbstractCuevas, A. G., McSorley, A. M., Lyngdoh, A., Kaba-Diakité, F., Harris, A., Rhodes-Bratton, B., & Rouhani, S. (n.d.).Publication year
2024Journal title
American journal of preventive medicineVolume
67Issue
1Page(s)
97-104AbstractIntroduction: Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities. Methods: Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023. Results: Having a college degree or more (b = −0.32; 95% CI: −0.46, −0.17), higher income (b = −0.06; 95% CI: −0.11, −0.01), and greater wealth (b = −0.11; 95% CI: −0.16, −0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities. Conclusions: Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.Emerging models of de facto drug policy reforms in the United States
AbstractRouhani, S., Zhang, L., Winiker, A. K., Sherman, S. G., & Bandara, S. (n.d.).Publication year
2024Journal title
Drug and alcohol dependenceVolume
260AbstractBackground: Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via prosecutorial discretion—or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD). Methods: We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach. Results: Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability. Conclusions: Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US.Epidemiology of drug arrests in the United States: Evidence from the national survey on drug use and health, 2015–2019
AbstractRouhani, S., Luo, L., Byregowda, H., Weaver, N., & Park, J. N. (n.d.).Publication year
2024Journal title
Preventive MedicineVolume
185AbstractObjective: Following changes to drug criminalization policies, we re-examine the epidemiology of drug arrests among people who use drugs (PWUD) in the U.S. Methods: Serial cross-sectional data from the National Survey on Drug Use and Health (2015–2019) were utilized. Past-year illicit drug use (excluding cannabis) and drug arrests were described by year, area of residence, drug use characteristics and participant demographics. Adjusted associations between race and drug arrest were estimated using multivariable logistic regression. Results: Past-year illicit drug use remained consistent over time and was highest among non-Hispanic (NH) white respondents. Of those reporting past-year illicit drug use (n = 25,429), prevalence of drug arrests remained stable over time overall and in metro areas while increasing in non-metro areas. Arrests were elevated among NH Black participants and those with lower income, unemployment, housing transience, non-metro area residence, polysubstance use, history of drug injection, substance use dependence and past-year drug selling. Adjusted odds of drug arrest remained significantly higher among NH Black individuals [aOR 1.92, 95% CI 1.30, 2.84]. Conclusion: Despite recent shifts away from punitive drug policies, we detected no reduction in drug arrests nationally and increasing prevalence in non-metro areas. Despite reporting the lowest level of illicit substance use and drug selling, NH Black individuals had significantly increased odds of arrest across years. Findings highlight the need for further examination of policy implementation and policing practices in different settings, with more research focused non-metro areas, to address enduring structural racism in drug enforcement and its consequences for health.Factors associated with daily use of benzodiazepines/tranquilizers and opioids among people who use drugs
AbstractKozak, Z., Urquhart, G. J., Rouhani, S., Allen, S. T., Park, J. N., & Sherman, S. G. (n.d.).Publication year
2024Journal title
American Journal on AddictionsVolume
33Issue
1Page(s)
83-91AbstractBackground: Co-use of benzodiazepines and opioids significantly increases fatal overdose risk, yet few studies have examined co-use of these drugs when obtained both with and without a prescription. We examined associations of daily co-use of prescribed benzodiazepines/tranquilizers (BZD/TRQ) and prescribed and nonprescribed opioids among people who use street opioids (PWUO). Methods: PWUO (N = 417) were recruited from Baltimore City and neighboring Anne Arundel County, Maryland, and surveyed on sociodemographic characteristics, structural vulnerabilities, healthcare access and utilization, substance use, and overdose experiences. Multivariable logistic regression was used to identify factors associated with self-reported co-use. Results: Participants were 46 years old on average, and predominantly Black (74%) males (62%). Daily co-use was reported by 22%. In multivariable analyses, odds of co-use were significantly higher among participants who did not have a high school degree/GED (adjusted odds ratio [aOR]: 1.71, 95% confidence interval [CI]: 1.02–2.88), endorsed receiving mental health treatment in the past 6 months (aOR: 2.13, 95% CI: 1.28–3.56), reported daily use of powdered cocaine (aOR: 3.57, 95% CI: 1.98–6.45), and synthetic cannabinoids (aOR: 3.11, 95% CI: 1.40–6.93). Odds of co-use were significantly lower among Black participants compared to white participants (aOR: 0.39, 95% CI: 0.19–0.82). Conclusions and Scientific Significance: Clinicians working with PWUO or who prescribe BZDs or opioids should screen patients who use cocaine or synthetic cannabinoids, have low level of educational attainment, or recently accessed mental health services, as these patients may be at higher risk for daily co-use of BZD/TRQ and opioids, and therefore lethal overdose.Love after lockup: examining the role of marriage, social status, and financial stress among formerly incarcerated individuals
AbstractBather, J. R., McSorley, A. M. M., Rhodes-Bratton, B., Cuevas, A. G., Rouhani, S., Nafiu, R. T., Harris, A., & Goodman, M. S. (n.d.).Publication year
2024Journal title
Health and JusticeVolume
12Issue
1AbstractBackground: Upon reintegration into society, formerly incarcerated individuals (FIIs) experience chronic financial stress due to prolonged unemployment, strained social relationships, and financial obligations. This study examined whether marriage and perceived social status can mitigate financial stress, which is deleterious to the well-being of FIIs. We also assessed whether sociodemographic factors influenced financial stress across marital status. We used cross-sectional data from 588 FIIs, collected in the 2023 Survey of Racism and Public Health. The financial stress outcome (Cronbach’s α = 0.86) comprised of five constructs: psychological distress, financial anxiety, job insecurity, life satisfaction, and financial well-being. Independent variables included marital and social status, age, race/ethnicity, gender identity, educational attainment, employment status, and number of dependents. Multivariable models tested whether financial stress levels differed by marital and perceived social status (individual and interaction effects). Stratified multivariable models assessed whether social status and sociodemographic associations varied by marital status. Results: We found that being married/living with a partner (M/LWP, b = -5.2) or having higher social status (b = -2.4) were protective against financial stress. Additionally, the social status effect was more protective among divorced, separated, or widowed participants (b = -2.5) compared to never married (NM, b = -2.2) and M/LWP (b = -1.7) participants. Lower financial stress correlated with Black race and older age, with the age effect being more pronounced among M/LWP participants (b = -9.7) compared to NM participants (b = -7.3). Higher financial stress was associated with woman gender identity (overall sample b = 2.9, NM sample b = 5.1), higher education (M/LWP sample b = 4.4), and having two or more dependents (overall sample b = 2.3, M/LWP sample b = 3.4). Conclusions: We provide novel insights into the interrelationship between marriage, perceived social status, and financial stress among FIIs. Our findings indicate the need for policies and programs which may target the family unit, and not only the individual, to help alleviate the financial burden of FIIs. Finally, programs that offer legal aid to assist in expungement or sealing of criminal records or those offering opportunities for community volunteer work in exchange for vouchers specific to legal debt among FIIs could serve to reduce financial stress and improve social standing.Public support for reinvesting resources from enforcing drug possession to health-promoting alternatives: A nationally representative poll of adults in the United States
AbstractTomko, C., Rouhani, S., LaSalle, L., & Sherman, S. G. (n.d.).Publication year
2024Journal title
International Journal of Drug PolicyVolume
126AbstractBackground: The legal enforcement of drug possession is associated with a host of negative consequences for people who use drugs (PWUD), has demonstrated little effectiveness at curbing drug use, and has contributed to lasting financial, social, and health-related racial disparities in Black and Brown communities in the United States (U.S.). One policy alternative is reinvesting resources typically used for enforcing drug possession into health-promoting services such as drug treatment or harm reduction that can better serve the needs of PWUD than the criminal legal system. We sought to characterize the prevalence and correlates of national public support for this reinvestment in the U.S. Methods: A nationally representative sample of U.S. adults (N = 1,212) completed the Johns Hopkins COVID-19 Civic Life and Public Health Survey (wave three, fielded November 11–30, 2020). The outcome is support for reinvestment of resources spent on enforcing drug possession into health-promoting alternatives (i.e., drug treatment, harm reduction, housing support, or community-based resources). We measured potential correlates including socio-demographics and social/political attitudes, including political ideology (conservative, moderate, liberal) and racial resentment toward the Black community. Analyses accounted for complex survey weights. Results: Weighted prevalence of support for reinvestment of resources was 80 %. Multivariable logistic regression (controlling for confounders) showed that white respondents were more likely than Black (OR = 2.51, 95% CI = 1.08, 5.87) to favor reinvestment. Respondents with moderate (OR = 0.34, 95 % CI = 0.15–0.79) or conservative (OR = 0.21, 95 % CI = 0.09–0.50) political ideology (compared to liberal) and medium (OR = 0.26, 95 % CI = 0.09–0.74) or high (OR = 0.12, 95 % CI = 0.04–0.35) levels of racial resentment (compared to low) were less likely to support reinvestment. Conclusion: There is substantial national support for reinvesting resources into health-promoting alternatives, though political ideology and racial resentment temper support. Results can inform targeted messaging to increase support for moving drug policy from the criminal legal sphere toward public health.Sleep-related impairment among people who use opioids: The critical role of structural vulnerability
AbstractSchneider, K. E., Martin, E. M., Urquhart, G. J., Sisson, L. N., Rouhani, S., Morris, M., Spira, A. P., & Sherman, S. G. (n.d.).Publication year
2024Journal title
Sleep HealthVolume
10Issue
5Page(s)
533-539AbstractObjective: People who use opioids are vulnerable to sleep disturbances due to a range of factors, including the substances they use and the various structural vulnerabilities they face. We aimed to understand the burden of sleep-related impairment and problems pertaining to sleep context and schedule among people who use opioids. Methods: We explored sleep quality and problems among a suburban sample of people who use opioids experiencing extensive structural vulnerabilities (N = 170). Participants reported their most urgent concern in the past week (e.g., sleep, drug use, housing), their sleep context, sleep problems, sleep schedules, and scores on the PROMIS Sleep-Related Impairment measure. We then quantified associations between Sleep-Related Impairment scores and sociodemographics and substance use. Results: Participants were primarily men (66%) and non-Hispanic Black (67%) with a mean age of 42 (SD: 12.1). Many experienced hunger (44%) and literal homelessness (40%). One-quarter (28%) reported that sleep was their most urgent concern in the past week. The most common problems when falling or staying asleep were mental health-related symptoms (81%) and pain/discomfort (32%). Literal homelessness (β = 2.2, 95% CI: 0.6, 3.7), hunger (β = 2.3, 95% CI: 1.0, 3.6), and frequent alcohol use (β = 1.5, 95% CI: 0.2, 2.7) were significantly associated with Sleep-Related Impairment scores. Conclusions: Homelessness and hunger are associated with sleep-related impairment in people who use opioids. Poor sleep quality, substance use, structural vulnerability, and mental health problems are all interrelated sources of functional impairment in this population. Interventions that address poverty as an underlying cause of sleep-related impairment and provide safe sleeping environments are needed.The effects of message framing on US police chiefs’ support for interventions for opioid use disorder: a randomized survey experiment
AbstractDel Pozo, B., Rouhani, S., Bailey, A., Clark, M. H., Martins, K. F., Ahmed, F. Z., Atkins, D., & Andraka-Christou, B. (n.d.).Publication year
2024Journal title
Health and JusticeVolume
12Issue
1AbstractBackground: US chiefs of police hold significant influence over the perceived acceptability and appropriateness of interventions for opioid use disorder (OUD) among the public, elected officials, and subordinate officers. This study assessed whether police chiefs’ support for such interventions was sensitive to framing an intervention’s benefits in terms that emphasize public health and harm reduction outcomes, versus terms typically indicative of public safety outcomes. Methods: A two-armed survey utilizing a randomized, between-subjects design tested framing-based variance in support among US chiefs of police for overdose prevention centers, syringe service programs (SSPs), Good Samaritan laws, police naloxone distribution, trustworthiness of officers in recovery from OUD, and related propositions. Of 1,200 invitations, 276 chiefs participated (23%). The two experimental arms (n = 133, n = 143) were demographically balanced between both each other and non-respondents. Results: Chiefs were more likely to agree that their mission was protecting public safety than protecting public health, even when both were defined using public health outcomes. Chiefs expressed significantly greater support for “overdose prevention sites” than “safe injection sites” (p =.018), low levels of support for SSPs regardless of framing (18% safety; 19% health), and comparably more support for Good Samaritan laws based on framing (62% safety vs. 54% health). Respondents voiced low levels of trust in officers recovering from OUD generally (31%), and significantly lower levels of trust when recovery involved the medication buprenorphine (10%; p <.001). Senior chiefs were significantly more likely to support SSPs (aOR 1.05; CI 1.01, 1.09) and overdose prevention sites (aOR 2.45; CI 1.13, 5.28) than less senior chiefs. Conclusions: In this cross-sectional survey experiment, support for some interventions for OUD was greater among US chiefs of police when framed to emphasize positive public safety outcomes. Research is required to better understand low support for SSPs, mistrust of officers in recovery for OUD, and greater support for OUD interventions among senior chiefs.Understaffed and beleaguered: a national survey of chiefs of police about the post-George Floyd era
AbstractDel Pozo, B., Rouhani, S., Clark, M. H., Atkins, D., Andraka-Christou, B., & Martins, K. F. (n.d.).Publication year
2024Journal title
PolicingVolume
47Issue
5Page(s)
846-860AbstractPurpose: The 2020 murder of George Floyd resulted in challenges to policing in the United States of America, but little is known about how police chiefs perceive them. At the same time, chiefs of police wield great influence over public perceptions of crime and disorder, the state of their profession, the laws and policies that govern the conduct of police officers and municipal public safety budgets. It is therefore critical to understand how police perceive the changes to their profession post-Floyd. Design/methodology/approach: This study surveyed a randomly selected national sample of 276 municipal chiefs of police. Items probed resignations, recruitment, efforts to defund departments, community support, officer morale, suspects’ likelihood of obeying lawful orders and career risks that could inhibit proactive police work. It examined associations between perceptions and Census Bureau region, length of tenure as chief, size of police department, population served and the urban or rural designation of the jurisdiction. Findings: Chiefs overwhelmingly reported recruiting qualified candidates had become much harder, and the present risks of proactive police work encourage inaction. Chiefs of agencies in the Northeast perceived more challenges than those in the South. Respondents with more years of experience were less likely to perceive the current situation as dire. Approximately 13.5% reported an attempt to defund their department, 56.8% of which yielded some success. Our study suggests an increase in the number and scope of challenges perceived by chiefs of police. Results vary by region and police chief years of experience. Originality/value: This study provides researchers and practitioners with the perspectives of chiefs about the post-Floyd era that influence their decisions, policies and initiatives.Understanding sensitivity and cross-reactivity of xylazine lateral flow immunoassay test strips for drug checking applications
AbstractSisco, E., Nestadt, D. F., Bloom, M. B., Schneider, K. E., Elkasabany, R. A., Rouhani, S., & Sherman, S. G. (n.d.).Publication year
2024Journal title
Drug Testing and AnalysisVolume
16Issue
9Page(s)
942-947AbstractThe continued prevalence of xylazine in the illicit drug market has necessitated development of quick and simple methods for identification, including lateral flow immunoassays (also known as “test strips”), like those frequently used to detect fentanyl. This study explored the drug checking applicability of the first publicly available xylazine test strips (XTS) using four sub-studies: reproducibility (i.e., consistency of positive results in a highly-concentrated xylazine solution); limit of detection on a calibration curve of xylazine concentrations; cross-reactivity against 77 commonly encountered drugs, cutting agents, and other structurally similar compounds; and applicability for analyzing community-acquired samples—where 100 drug residue samples were analyzed using XTS, direct analysis in real time mass spectrometry (DART-MS), and gas chromatography tandem mass spectrometry (GC–MS/MS). XTS consistently detected xylazine at concentrations ≥2.5 μg/ml, and XTS results were reproducible. Sensitivity and specificity of XTS were calculated by comparing expected versus obtained results based on xylazine concentration of community-acquired samples measured by GC-MS/MS. XTS consistently detected xylazine in samples with concentration >2 μg/ml and yielded a sensitivity of 0.974, specificity of 1.00, and overall accuracy of 0.986. Cross-reactivity with lidocaine, a common cutting agent, and lack of XTS reactivity with other α2-agonists found in the illicit drug supply highlight the need to offer consumers comprehensive drug checking services that identify a range of substances and better inform them about drug contents.“What I should be doing is harm reduction, if I'm doing my job right”: Engagement with harm reduction principles among prosecutors enacting drug policy reform in the United States
AbstractRouhani, S., Winiker, A. K., Zhang, L., Sherman, S. G., & Bandara, S. (n.d.).Publication year
2024Journal title
International Journal of Drug PolicyVolume
131AbstractBackground: Prosecutorial discretion to pursue or decline criminal charges is a powerful mechanism determining criminal justice outcomes among people who use drugs (PWUD). In the US, prosecutors are increasingly employing this tool to prevent arrest, incarceration, and subsequent health and social harms among PWUD. Many cite harm reduction as a basis for these reforms; however, the extent of prosecutors' knowledge and understanding of harm reduction principles, and how they are operationalized in the policy process, remains unclear. Methods: We assess references to and application of harm reduction in the policy design and implementation process of prosecutorial drug policy reform in 14 US jurisdictions. In-depth-interviews (N = 16) were conducted with elected prosecutors and their policy staff from November 2021-April 2022. Through initial structured analysis, policymakers’ understanding and utilization of the term ‘harm reduction’ emerged as a salient theme which we conducted secondary thematic analysis to further explore. Results: While all participants identified as progressive, there was wide variation in their ideologies, policy provisions, and engagement with harm reduction principles. Eleven participants explicitly referred to ‘reducing harms of drug use’ or ‘harm reduction’ as guiding their policy approach; the remainder did not invoke ‘harm reduction’ by name but highlighted relevant concepts like racial equity and ‘public health approaches’ as core policy tenets. While some prosecutors demonstrated familiarity with traditional harm reduction principles (meeting PWUD where they are, reducing harms to them), others focused on harm to the wider community (the ‘public,’ businesses, etc). Invocation of harm reduction was not always consistent with specific policy provisions: prosecutors implemented policies ranging from unconditional non-prosecution of drug possession to diversion, some of which were odds with core harm reduction principles of dignity and justice (i.e., involving coercive treatment incentives/requirements). Conclusions: As prosecutors shift their approach to redress the harms caused by drug criminalization, clarity is needed on what a harm reduction approach to using discretionary powers entails. Targeting reform-minded prosecutors with messaging on the principles, evidence base, and best practices of harm reduction is merited.De Facto Decriminalization for Drug Possession and Sex Work in Baltimore, Maryland
Sherman, S. G., Tomko, C., & Rouhani, S. (n.d.).Publication year
2023Journal title
American journal of preventive medicineVolume
64Issue
4Page(s)
567-568Disruptions to naloxone training among lay and occupational responders in Maryland during the emergence of COVID-19: Early impacts, recovery, and lessons learned
AbstractByregowda, H., Tomko, C., Schneider, K. E., Russell, E., Johnson, R. M., Susukida, R., Rouhani, S., Parnham, T., & Park, J. N. (n.d.).Publication year
2023Journal title
Drug and Alcohol Dependence ReportsVolume
8AbstractBackground: Opioid overdose death rates increased during the COVID-19 pandemic. Disruptions in community-based naloxone trainings could have reduced the likelihood of overdose reversal and increased the chances of a fatal overdose. We investigated changes in the number of people trained in naloxone administration and distribution in Maryland before, during, and after COVID-related stay-at-home orders. Methods: Data on naloxone training are from the Maryland Department of Health. We used interrupted time series models to estimate changes in average monthly number of people trained: [1] pre-interruption (4/2019–3/2020), [2] 1-month post-interruption (4/2020–5/2020), and [3] 12-month post-interruption (4/2020–3/2021). Trainees were classified as lay (e.g., people who use drugs) or occupational (e.g., law enforcement officers and harm reduction workers) responders. Results: There were 101,332 trainees; 54.1% lay, 21.5% occupational, and 23.4% unknown responder status. We observed a decrease in the average monthly number of trainees in the pre-interruption period (-235, p<0.001), a larger decrease of 93.2% during the 1-month post-interruption (-846, p = 0.013), and an increase during the 12-month post-interruption (+217, p<0.001). There was a significant decrease among occupational responders 1-month post-interruption, and a significant increase among lay responders in the 12-month post-interruption period. Conclusions: Findings suggest a marked decrease in naloxone trainees immediately after stay-at-home order, followed by a moderate rebound in the 12-months after stay-at-home order. The decrease in occupational responders trained may have limited access to naloxone, but would likely have been offset by increases in number of lay responders trained. Strengthening lay and occupational responder connections could maintain naloxone distribution during public health crises.Factors associated with receptive injection equipment sharing among people who inject drugs: findings from a multistate study at the start of the COVID-19 pandemic
AbstractAllen, S. T., Schneider, K. E., Morris, M., Rouhani, S., Harris, S. J., Saloner, B., & Sherman, S. G. (n.d.).Publication year
2023Journal title
Harm Reduction JournalVolume
20Issue
1AbstractBackground: Receptive injection equipment sharing (i.e., injecting with syringes, cookers, rinse water previously used by another person) plays a central role in the transmission of infectious diseases (e.g., HIV, viral hepatitis) among people who inject drugs. Better understanding these behaviors in the context of COVID-19 may afford insights about potential intervention opportunities in future health crises. Objective: This study examines factors associated with receptive injection equipment sharing among people who inject drugs in the context of COVID-19. Methods: From August 2020 to January 2021, people who inject drugs were recruited from 22 substance use disorder treatment programs and harm reduction service providers in nine states and the District of Columbia to complete a survey that ascertained how the COVID-19 pandemic affected substance use behaviors. We used logistic regression to identify factors associated with people who inject drugs having recently engaged in receptive injection equipment sharing. Results: One in four people who inject drugs in our sample reported having engaged in receptive injection equipment sharing in the past month. Factors associated with greater odds of receptive injection equipment sharing included: having a high school education or equivalent (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [95% CI] 1.24, 3.69), experiencing hunger at least weekly (aOR = 1.89, 95% CI 1.01, 3.56), and number of drugs injected (aOR = 1.15, 95% CI 1.02, 1.30). Older age (aOR = 0.97, 95% CI 0.94, 1.00) and living in a non-metropolitan area (aOR = 0.43, 95% CI 0.18, 1.02) were marginally associated with decreased odds of receptive injection equipment sharing. Conclusions: Receptive injection equipment sharing was relatively common among our sample during the early months of the COVID-19 pandemic. Our findings contribute to existing literature that examines receptive injection equipment sharing by demonstrating that this behavior was associated with factors identified in similar research that occurred before COVID. Eliminating high-risk injection practices among people who inject drugs requires investments in low-threshold and evidence-based services that ensure persons have access to sterile injection equipment.High willingness to use overdose prevention sites among suburban people who use drugs who do not inject
AbstractSchneider, K. E., Urquhart, G. J., Rouhani, S., Allen, S. T., Morris, M., & Sherman, S. G. (n.d.).Publication year
2023Journal title
Harm Reduction JournalVolume
20Issue
1AbstractIntroduction: Overdose prevention sites (OPS) are evidence-based interventions to improve public health, yet implementation has been limited in the USA due to a variety of legal impediments. Studies in various US settings have shown a high willingness to use OPS among urban and rural people who inject drugs, but data among people who use drugs (PWUD) via non-injection routes of administration in suburban areas are lacking. Methods: We utilized cross-sectional data from a sample of suburban PWUD who have not injected drugs in the past 3 months (N = 126) in Anne Arundel County, Maryland. We assessed PWUDs’ likelihood of using a hypothetical OPS and perceived potential barriers to accessing OPS. We tested for associations between sociodemographic characteristics, drug use, service access, and overdose experiences with willingness to utilize OPS. Findings: Participants’ median age was 42, and the majority were men (67%) and non-Hispanic Black (79%). Sixty-six percent reported willingness to use an OPS. Concerns about confidentiality (29%), arrest (20%), and transportation costs (22%) were the most anticipated barriers to using OPS. Men (75% vs 55%, p = 0.015), participants who used heroin (53% vs 32%, p = 0.017), and participants who used multiple overdose prevention behaviors (e.g., using fentanyl test strips) (36% vs 19%, p = 0.006) were more likely to report willingness to use OPS. Conclusion: Most suburban non-injecting PWUD in the sample were willing to use an OPS. OPS implementation strategies in suburban settings should be tailored to reach PWUD via non-injection routes of administration while meeting the unique needs of suburban contexts.