Saba Rouhani

Assistant Professor of Epidemiology

Professional overview

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.

Education

PhD Global Disease Epidemiology & Control, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

MS Control of Infectious Diseases, The London School of Hygiene & Tropical Medicine, London, United Kingdom

BS Medical Microbiology, University of Edinburgh, Edinburgh, United Kingdom

Honors and awards

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)

Publications

Publications

HIV Risk Among Urban and Suburban People Who Inject Drugs : Elevated Risk Among Fentanyl and Cocaine Injectors in Maryland

Park, J. N., Owczarzak, J., Urquhart, G., Morris, M., Weicker, N. P., Rouhani, S., & Sherman, S. G. (n.d.).

Publication year

2022

Journal title

AIDS and Behavior

Volume

26

Issue

1

Page(s)

277-283

10.1007/s10461-021-03381-y

Abstract

Abstract

Drug overdose remains a leading cause of death in the US, with growing rates attributable to illicit fentanyl use. Recent HIV outbreaks among people who inject drugs (PWID) and service disruptions from COVID-19 have renewed concerns on HIV resurgence. We examined the relationship between fentanyl use and three injection-related HIV risk behaviors among PWID in Baltimore City (BC) and Anne Arundel Country (AAC), Maryland. PWID (N = 283) were recruited to the study through targeted sampling at street-based locations in BC and AAC from July 2018 to March 2020. Receptive syringe sharing (RSS) [adjusted odds ratio (AOR): 2.8, 95% confidence interval (CI): 1.2–6.3] and daily injecting (AOR: 1.9, 95% CI: 1.0–3.6) were associated with injecting fentanyl and cocaine together. Fentanyl availability and COVID-19 bring new HIV prevention challenges, particularly among those who inject fentanyl with cocaine, highlighting the importance to expand and sustain harm reduction, prevention, and treatment services for PWID to reduce HIV and overdose burden.

Homotypic and Heterotypic Protection and Risk of Reinfection following Natural Norovirus Infection in a Highly Endemic Setting

Chhabra, P., Rouhani, S., Browne, H., Peñataro Yori, P., Siguas Salas, M., Paredes Olortegui, M., Moulton, L. H., Kosek, M. N., & Vinjé, J. (n.d.).

Publication year

2021

Journal title

Clinical Infectious Diseases

Volume

72

Issue

2

Page(s)

222-229

10.1093/cid/ciaa019

Abstract

Abstract

Background: Norovirus is a leading cause of acute gastroenteritis worldwide, yet there is limited information on homotypic or heterotypic protection following natural infection to guide vaccine development. Methods: A total of 6020 stools collected from 299 Peruvian children between 2010 and 2014 were tested by norovirus real-time reverse-transcription polymerase chain reaction followed by sequence-based genotyping. Cox proportional hazards models were used to derive adjusted hazard ratios (HRs) of infection among children with vs without prior exposure. Results: Norovirus was detected in 1288 (21.3%) samples. GII.4 (26%), GII.6 (19%), and GI.3 (9%) viruses accounted for 54% of infections. Homotypic protection for GI.3 (HR, 0.35; P=.015), GI.7 (HR, 0.19; P=.022), GII.4 (HR, 0.39; P

Identifying pathways to recent non-fatal overdose among people who use opioids non-medically : How do psychological pain and unmet mental health need contribute to overdose risk?

Tomko, C., Schneider, K. E., Rouhani, S., Urquhart, G. J., Nyeong Park, J., Morris, M., & Sherman, S. G. (n.d.).

Publication year

2022

Journal title

Addictive Behaviors

Volume

127

10.1016/j.addbeh.2021.107215

Abstract

Abstract

Background: Significant associations exist between psychological pain, unmet mental health need, and frequency and severity of substance use among people who use drugs (PWUD), but no studies have analyzed the relationship of these variables to non-fatal overdose. Methods: We conducted a cross-sectional survey of people who used opioids non-medically in Baltimore, Maryland (n = 563) as part of a broader harm reduction-focused evaluation (PROMOTE). The outcome was self-reported recent (past 6 months) non-fatal overdose; exposures of interest were recent self-reported unmet mental health need, experiencing daily “long-lasting psychological or mental pain” (vs. < daily), and daily multi-opioid use (vs. none/one opioid used). Path analysis was used to model direct relationships between these variables, personal characteristics (race, gender, experiencing homelessness, drug injection) and overdose. Results: 30% of the sample had experienced a recent non-fatal overdose, 46% reported unmet mental health need, 21% reported daily psychological pain, and 62% used multiple types of opioids daily. After adjusting for covariates, daily multi-opioid use (aOR = 1.78, p = 0.03) and unmet mental health need (aOR = 2.05, p = 0.01) were associated with direct, significant increased risk of recent overdose. Significant pathways associated with increased odds of unmet mental health need included woman gender (aOR = 2.23, p = 0.003) and daily psychological pain (aOR = 4.14, p = 0.002). In turn, unmet mental health need associated was with greater odds of daily multi-opioid use (aOR = 1.57, p = 0.05). Discussion: Unmet mental heath need and daily psychological pain are common experiences in this sample of PWUD. Unmet mental health need appears on several pathways to overdose and associated risk factors; improving access to mental healthcare for PWUD (particularly women) expressing need may be an important harm reduction measure.

Impact of a malaria intervention package in schools on Plasmodium infection, anaemia and cognitive function in schoolchildren in Mali : A pragmatic cluster-randomised trial

Clarke, S. E., Rouhani, S., Diarra, S., Saye, R., Bamadio, M., Jones, R., Traore, D., Traore, K., Jukes, M. C., Thuilliez, J., Brooker, S., Roschnik, N., & Sacko, M. (n.d.).

Publication year

2017

Journal title

BMJ Global Health

Volume

2

Issue

2

10.1136/bmjgh-2016-000182

Abstract

Abstract

Background School-aged children are rarely targeted by malaria control programmes, yet the prevalence of Plasmodium infection in primary school children often exceeds that seen in younger children and could affect haemoglobin concentration and school performance. Methods A cluster-randomised trial was carried out in 80 primary schools in southern Mali to evaluate the impact of a school-based malaria intervention package. Intervention schools received two interventions sequentially: (1) teacher-led participatory malaria prevention education, combined with distribution of long-lasting insecticidal nets (LLINs), followed 7 months later at the end of the transmission season by (2) mass delivery of artesunate and sulfadoxine-pyrimethamine administered by teachers, termed intermittent parasite clearance in schools (IPCs). Control schools received LLINs as part of the national universal net distribution programme. The impact of the interventions on malaria and anaemia was evaluated over 20 months using cross-sectional surveys in a random subset of 38 schools(all classes), with a range of cognitive measures (sustained attention, visual search, numeracy, vocabulary and writing) assessed in a longitudinal cohort of children aged 9–12 years in all 80 schools. results Delivery of a single round of IPCs was associated with dramatic reductions in malaria parasitaemia (OR 0.005, 95% CI 0.002 to 0.011, p

Implementation of Overdose Prevention in Maryland : Implications for Resource Allocation, Program Scale-Up, and Evaluation

Tomko, 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

2023

Journal title

Health promotion practice

10.1177/15248399231209935

Abstract

Abstract

Overdose 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.

Implications of attitudes and beliefs about COVID-19 vaccines for vaccination campaigns in the United States : A latent class analysis

Schneider, K. E., Dayton, L., Rouhani, S., & Latkin, C. A. (n.d.).

Publication year

2021

Journal title

Preventive Medicine Reports

Volume

24

10.1016/j.pmedr.2021.101584

Abstract

Abstract

Unprecedented global efforts in vaccine development have resulted in effective vaccines for COVID-19. The pandemic response in the US has been highly politicized, resulting in significant opposition to public health efforts, including vaccines. We aimed to understand patterns of attitudes and beliefs about the COVID-19 vaccine to inform vaccination campaigns. 583 English speaking United States adults were surveyed November 18–29, 2020. Participants answered 11 questions about their attitudes and beliefs about a COVID-19 vaccine, including perceived vaccine effectiveness, likelihood of getting vaccinated, and concerns that vaccine development was rushed/influenced by politics. We conducted a latent class analysis to identify profiles of attitudes/beliefs about a COVID-19 vaccine. We identified four classes of COVID-19 vaccine beliefs. The pro-vaccine class (28.8%) was willing to get vaccinated and had broadly positive beliefs about the vaccine. The development concerns class (27.8%) was willing to get vaccinated but was concerned about the development process. The third class (22.6%) was largely unsure if they would get vaccinated and if their peer groups would be vaccinated. The forth class (anti-vaccine, 20.8%) was dominated by an unwillingness to get vaccinated, vaccine distrust, vaccine development concerns, and peers groups with negative vaccine intentions. Given the large proportion of individuals who were concerned about the COVID-19 vaccine development process, messaging about rigor and approval processes may be critical to securing this group's commitment to vaccination. Having scientific and cultural leaders endorse vaccination may also be influential.

Incidence and predictors of violence from clients, intimate partners and police in a prospective US-based cohort of women in sex work

Decker, M., Rouhani, S., Park, J. N., Galai, N., Footer, K., White, R., Allen, S., & Sherman, S. (n.d.).

Publication year

2021

Journal title

Occupational and Environmental Medicine

Volume

78

Issue

3

Page(s)

160-166

10.1136/oemed-2020-106487

Abstract

Abstract

Objective Gender-based violence threatens women's health and safety. Female sex workers (FSWs) experience violence disproportionately, yet prospective data on violence predictors is lacking. In the first US-based prospective FSW cohort study, we examine incidence rates (IRs) and predictors of violence from distinct perpetrators: paying clients, non-paying intimate partners and police. Methods The parent cohort (Sex Workers and Police Promoting Health In Risky Environments) recruited street-based cisgender FSWs in urban Baltimore, MD (n=250) with 5 assessments at 3-month intervals through 12-month follow-up. Stratifying by violence perpetrator, we characterise violence at baseline, IR over the study period and time-varying predictors using Poisson models. Results The violence IR per person year was highest for client-perpetrated violence (0.78), followed by intimate partner violence (IPV; IR 0.39), and police violence (IR 0.25). Prevalence over the 12-month follow-up period among participants with complete visit data (n=103), was 42% for client violence, 22% for IPV and 16% for police violence. In adjusted analyses, risk factors for incident violence varied across perpetrators and included entry to sex work through force or coercion (adjusted IR ratio (aIRR) IPV 2.0; 95% CI 1.2 to 3.6), homelessness (aIRR IPV 2.0; 95% CI 1.3 to 2.9; aIRR police 2.7; 95% CI 1.3 to 5.8) and daily injection drug use (aIRR client 1.9; 95% CI 1.2 to 3.0). Risk of incident client violence and IPV was elevated by past abuse from each respective perpetrator. Help-seeking following abuse was limited. Conclusions FSWs face profound, enduring risk for violence from a range of perpetrators, likely enabled by criminalisation-related barriers to justice and perpetrator impunity. FSWs represent a priority population for access to justice, trauma-informed healthcare and violence-related support services. Structural vulnerabilities including homelessness and addiction represent actionable priorities for improving safety and health.

Increased solitary drug use during COVID-19 : An unintended consequence of social distancing

Schneider, K. E., Allen, S. T., Rouhani, S., Morris, M., Haney, K., Saloner, B., & Sherman, S. G. (n.d.).

Publication year

2023

Journal title

International Journal of Drug Policy

Volume

111

10.1016/j.drugpo.2022.103923

Abstract

Abstract

Background: During the COVID-19 pandemic, overdose rates substantially increased in the United States. One possible contributor to this phenomenon may be solitary drug use resulting from social distancing efforts to prevent COVID-19 transmission. Methods: We surveyed 458 people who use drugs (PWUD) who were recruited from harm reduction and drug treatment providers located in nine states and the District of Columbia. We assessed if solitary drug use had increased since the start of COVID-19. Associations between increased solitary drug use and sociodemographic characteristics, drug use characteristics, and COVID-19 prevention behaviors were examined using multiple logistic regression. Results: Half the sample identified as men (52.7%), White (49.7%), and single (49.3%). The average age was 43.2 (SD:11.8) years. Two-thirds (66.8%) recently injected drugs. 44% reported increased solitary drug use since COVID-19. Significant correlates of increased solitary drug use included being single (adjusted Odds Ratio [aOR]=1.99, 95% Confidence Interval [CI]: 1.33, 2.98), increasing drug use (aOR=2.74, 95% CI: 1.72, 4.37), using more in private locations (aOR=1.91, 95% CI: 1.34, 2.72), and social distancing behaviors (aOR=1.31, 95% CI: 1.11, 1.54). Experiencing homelessness (aOR=0.45, 95% CI: 0.31, 0.65) and identifying as a sexual minority (aOR=0.53, 95% CI: 0.31, 0.93) were associated with being less likely to increase solitary drug use. Conclusions: Solitary drug use increased during the COVID-19 pandemic. Increases in solitary drug use, in the context of a drug market increasingly permeated by fentanyl, indicates an urgent need for comprehensive harm reduction interventions to reduce overdose mortality.

Interest in treatment with injectable diacetylmorphine among people who use opioids in Baltimore City, Maryland (USA)

Allen, S. T., Schneider, K. E., Rouhani, S., White, R. H., Morris, M., Owczarzak, J., & Sherman, S. G. (n.d.).

Publication year

2023

Journal title

Annals of Medicine

Volume

55

Issue

1

10.1080/07853890.2023.2196435

Abstract

Abstract

Introduction: Treatment for opioid use disorder (OUD) with diacetylmorphine is an evidence-based form of drug treatment, but it is not available in the United States (US). Better understanding acceptability of treatment with injectable diacetylmorphine among people who use opioids (PWUO) in the US may expedite future initiatives designed to engage persons in this form of treatment should it become available. The purpose of this research is to examine factors associated with interest in treatment with injectable diacetylmorphine among a sample of PWUO in the US. Methods: Data are from a cross-sectional study of PWUO in Baltimore City, Maryland. Participants were given a brief description of treatment with injectable diacetylmorphine and then asked to rate their level of interest. We used Poisson regression with robust variance to assess factors associated with interest in treatment with injectable diacetylmorphine. Results: The average age of participants was 48 years, 41% were women, and most (76%) identified as non-Hispanic, Black. The most commonly used substances were non-injection heroin (76%), opioid pain relievers (73%), and non-injection crack/cocaine (73%). Two-thirds of participants (68%) indicated interest in treatment with injectable diacetylmorphine. Factors significantly associated with interest in injectable diacetylmorphine treatment included: having at least a high school education (adjusted prevalence ratio [aPR]: 1.23; 95% confidence interval [CI]: 1.04–1.45), not having health insurance (aPR: 1.23; 95% CI: 1.06–1.44), having ever overdosed (aPR: 1.20; 95% CI: 1.01–1.42), and past utilization of medications for opioid use disorder (aPR: 1.22; 95% CI: 1.01–1.47). Recent non-injection cocaine use was inversely associated with interest in treatment with injectable diacetylmorphine (aPR 0.80; 95% CI: 0.68–0.94). Conclusion: The majority of participants reported interest in treatment with injectable diacetylmorphine. Given worsening trends in the addiction and overdose crisis in the US, treatment with injectable diacetylmorphine should be considered as another evidence-based option for treating OUD.KEY MESSAGES Interest in treatment with injectable diacetylmorphine was high among a sample of people who use opioids in the United States. Factors associated with increased interest in treatment with injectable diacetylmorphine included having at least a high school education, having ever overdosed, and not having health insurance. Past utilization of medications for opioid use disorder was associated with interest in treatment with injectable diacetylmorphine.

Love after lockup : examining the role of marriage, social status, and financial stress among formerly incarcerated individuals

Bather, J. R., McSorley, A. M., Rhodes-Bratton, B., Cuevas, A., Rouhani, S., Nafiu, R. T., Harris, A., & Goodman, M. (n.d.).

Publication year

2024

Journal title

Health and Justice

Volume

12

Issue

1

10.1186/s40352-024-00264-x

Abstract

Abstract

Background: 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.

 Love After Lockup: Examining the Role of Marriage, Social Status, and Financial Stress Among Formerly Incarcerated Individuals. 

Goodman, M., Bather, J. R., Cuevas, A., & Rouhani, S. (n.d.).

Publication year

2024

Journal title

Health Justice

Volume

12

Issue

7

Abstract

Abstract

~

NIMBYism and Harm Reduction Programs : Results from Baltimore City

Rouhani, S., Schneider, K. E., Weicker, N., Whaley, S., Morris, M., & Sherman, S. G. (n.d.).

Publication year

2022

Journal title

Journal of Urban Health

Volume

99

Issue

4

Page(s)

717-722

10.1007/s11524-022-00641-7

Abstract

Abstract

~

Norovirus infection and acquired immunity in 8 countries : Results from the MAL-ED study

Rouhani, S. (n.d.).

Publication year

2016

Journal title

Clinical Infectious Diseases

Volume

62

Issue

10

Page(s)

1210-1217

10.1093/cid/ciw072

Abstract

Abstract

Background. Norovirus is an important cause of childhood diarrhea. We present data from a longitudinal, multicountry study describing norovirus epidemiology during the first 2 years of life. Methods. A birth cohort of 1457 children across 8 countries contributed 7077 diarrheal stools for norovirus testing. A subset of 199 children contributed additional asymptomatic samples (2307) and diarrheal stools (770), which were used to derive incidence rates and evaluate evidence for acquired immunity. Results. Across sites, 89% of children experienced at least 1 norovirus infection before 24 months, and 22.7% of all diarrheal stools were norovirus positive. Severity of norovirus-positive diarrhea was comparable to other enteropathogens, with the exception of rotavirus. Incidence of genogroup II (GII) infection was higher than genogroup I and peaked at 6-11 months across sites. Undernutrition was a risk factor for symptomatic norovirus infection, with an increase in 1 standard deviation of length-for-age z score associated with a 17% reduction (odds ratio, 0.83 [95% confidence interval,. 72-.97]; P =. 011) in the odds of experiencing diarrhea when norovirus was present, after accounting for genogroup, rotavirus vaccine, and age. Evidence of acquired immunity was observed among GII infections only: Children with prior GII infection were found to have a 27% reduction in the hazard of subsequent infection (hazard ratio, 0.727; P =. 010). Conclusions. The high prevalence of norovirus across 8 sites in highly variable epidemiologic settings and demonstration of protective immunity for GII infections provide support for investment in vaccine development.

Pathways to racial disparities in the effects of Good Samaritan Laws : A mixed methods pilot study

Pamplin, J. R., King, C., Cooper, C., Bennett, A. S., Elliott, L. C., Davis, C. S., Rouhani, S., & Townsend, T. N. (n.d.).

Publication year

2023

Journal title

Drug and alcohol dependence

Volume

249

10.1016/j.drugalcdep.2023.110823

Abstract

Abstract

Background: Drug overdose deaths continue to rise, and considerable racial inequities have emerged. Overdose Good Samaritan laws (GSLs) are intended to encourage overdose witnesses to seek emergency assistance. However, evidence of their effectiveness is mixed, and little is known regarding racial disparities in their implementation. This study examined GSL impact by assessing racial differences in awareness of and trust in New York state's GSL. Methods: Using a sequential mixed methods design, Black and white participants were recruited from an existing longitudinal cohort study of people who use illicit opioids in New York City to participate in a quantitative survey and qualitative interviews. Racially stratified survey responses were analyzed using chi-squared tests, Fisher exact tests, or t-tests. Qualitative interviews were analyzed using a hybrid inductive-deductive approach. Results: Participants (n=128) were 56% male and predominantly aged 50 years or older. Most met criteria for severe opioid use disorder (81%). Fifty-seven percent reported that the New York GSL makes them more likely to call 911 even though 42% reported not trusting law enforcement to abide by the GSL; neither differed by race. Black people were less likely to have heard of the GSL (36.1% vs 60%) and were less likely to have accurate information regarding its protections (40.4% vs 49.6%). Conclusions: Though GSLs may reduce negative impacts of the criminalization of people who use drugs, their implementation may exacerbate existing racial disparities. Resources should be directed towards harm reduction strategies that do not rely on trust in law enforcement.

Perceived vulnerability to overdose-related arrests among people who use drugs in Maryland

Rouhani, S., Schneider, K. E., Rao, A., Urquhart, G. J., Morris, M., LaSalle, L., & Sherman, S. G. (n.d.).

Publication year

2021

Journal title

International Journal of Drug Policy

Volume

98

10.1016/j.drugpo.2021.103426

Abstract

Abstract

Background: People who use drugs (PWUD) must weigh complex legal scenarios when seeking help during overdose events. Good Samaritan laws (GSL) offer limited immunity for certain low-level drug crimes to encourage PWUD to call 911. Drug-induced homicide laws (DHL) allow for criminal prosecution of people delivering drugs that result in overdose death and may exert opposing effects on the decision-making process. We examined whether perceptions of these laws were related to overall perceived vulnerability to overdose-related arrests, which can impact help-seeking and overdose mortality. Methods: We conducted a cross-sectional study of PWUD (N = 173) in Anne Arundel County, Maryland and measured sociodemographic characteristics, structural vulnerabilities, and knowledge of GSL and DHL. Perceived vulnerability to overdose-related arrest was defined as self-reported concern arising from calling 911, receiving medical help, or supplying drugs in the event of an overdose. Multivariable logistic regression was used to identify significant correlates of perceived vulnerability to overdose-related arrest. Results: Most participants were aware of DHL (87%) and half were aware of GSL (53%). Forty-seven percent of PWUD expressed concern about arrest during or due to an overdose. After adjustment, positive correlates of perceived vulnerability to arrest were non-white race (aOR 2.0, 95% CI 1.5-2.5) and hearing of somebody charged with DHL (aOR 3.1, 95%CI 1.9-5.0), and negative correlates were history of drug treatment (aOR 0.6, 95%CI 0.4-1.0), receiving naloxone (aOR 0.6, 95% CI 0.4-1.0), and having made, sold or traded drugs in the past 3 months (aOR 0.4, 95% CI 0.2-0.9). Conclusions: We report persisting concern about arrest during overdose events among street-based PWUD facing a complicated landscape of legal protections and liabilities. Findings demonstrate clear racial disparities in concern outside of an urban centre, where impacts of policing on health are less studied, and present evidence that DHL may compromise overdose prevention efforts. Changes to drug policy and enforcement including police nonattendance at overdose scenes may be necessary to promote help-seeking among PWUD and reduce overdose fatalities.

Persistent Criminalization and Structural Racism in US Drug Policy : The Case of Overdose Good Samaritan Laws

Pamplin, J. R., Rouhani, S., Davis, C. S., King, C., & Townsend, T. N. (n.d.).

Publication year

2023

Journal title

American journal of public health

Volume

113

Issue

S1

Page(s)

S43-S48

10.2105/AJPH.2022.307037

Abstract

Abstract

The US overdose crisis continues to worsen and is disproportionately harming Black and Hispanic/Latino people. Although the "War on Drugs" continues to shape drug policy-at the disproportionate expense of Black and Hispanic/Latino people-states have taken some steps to reduce War on Drugs-related harms and adopt a public health-centered approach. However, the rhetoric regarding these changes has, in many cases, outstripped reality. Using overdose Good Samaritan Laws (GSLs) as a case study, we argue that public health-oriented policy changes made in some states are undercut by the broader enduring environment of a structurally racist drug criminalization agenda that continues to permeate and constrict most attempts at change. Drawing from our collective experiences in public health research and practice, we describe 3 key barriers to GSL effectiveness: the narrow parameters within which they apply, the fact that they are subject to police discretion, and the passage of competing laws that further criminalize people who use illicit drugs. All reveal a persisting climate of drug criminalization that may reduce policy effectiveness and explain why current reforms may be destined for failure and further disadvantage Black and Hispanic/Latino people who use drugs. (Am J Public Health. 2023;113(S1):S43-S48. https://doi.org/10.2105/AJPH.2022.307037).

Police attitudes towards pre-booking diversion in Baltimore, Maryland

Rouhani, S., Gudlavalleti, R., Atzmon, D., Park, J. N., Olson, S. P., & Sherman, S. G. (n.d.).

Publication year

2019

Journal title

International Journal of Drug Policy

Volume

65

Page(s)

78-85

10.1016/j.drugpo.2018.11.012

Abstract

Abstract

Background: In the context of high rates of drug-related incarceration that disproportionately affect urban communities of colour, advocates for drug policy criminal justice reform have called for alternatives to mass incarceration. The Law Enforcement Assisted Diversion (LEAD) program redirects low-level drug offenders to health and social services rather than immediately into the criminal justice system. In advance of piloting LEAD in Baltimore City, we assessed police perceptions towards harm reduction and specifically pre-booking diversion in effort to inform training and implementation activities in Baltimore City and elsewhere. Methods: We administered a survey to Baltimore City Police Officers (N = 83) in the planned implementation district using two scales: the first measured police attitudes toward people who use drugs (PWUD), current drug policies and public health measures, and the second measured police perceptions of pre-booking diversion programs. We calculated Cronbach's alpha (α) to assess internal consistency of both scales. Bivariate χ 2 tests and multivariate logistic regression examined correlates of scale items stratified by new and seasoned officers. Results: Seasoned officers were significantly less likely to believe that drug treatment is easily available (51% vs. 81%, p = 0.005). The belief that current policies are effective and that PWUD should be arrested for small drug purchases decreased significantly per year on the force (aOR: 0.92; 95%CI 0.85,0.99; aOR: 0.94, 95% CI 0.88, 0.99, respectively), as did concerns about needle-stick injuries (aOR: 0.85, 95% CI 0.74, 0.98). Seasoned officers were significantly more comfortable referring PWUD to social services (100% vs. 83%, p = 0.006), and agree that such pre-booking diversion could be effective in improving public safety within (72% vs. 43%; p = 0.009) and beyond the intervention area (56% vs. 33%, p = 0.04). Conclusions: The study indicates the value of intervening early and consistently throughout police career trajectories and engaging seasoned officers as allies to promote recognition and support of public health and harm reduction strategies within ongoing police reform efforts. LEAD provides important and broad opportunities for training police to enhance their understanding the intersection of public safety and public health.

Practical implications of naloxone knowledge among suburban people who use opioids

Schneider, K. E., Urquhart, G. J., Rouhani, S., Park, J. N., Morris, M., Allen, S. T., & Sherman, S. G. (n.d.).

Publication year

2021

Journal title

Harm Reduction Journal

Volume

18

Issue

1

10.1186/s12954-021-00466-8

Abstract

Abstract

Background: Naloxone distribution programs have been a cornerstone of the public health response to the overdose crisis in the USA. Yet people who use opioids (PWUO) continue to face a number of barriers accessing naloxone, including not knowing where it is available. Methods: We used data from 173 PWUO from Anne Arundel County, Maryland, which is located between Baltimore City and Washington, DC. We assessed the prevalence of recently (past 6 months) receiving naloxone and currently having naloxone, the type(s) of the naloxone kits received, and the perceived ease/difficultly of accessing naloxone. We also assessed participants knowledge of where naloxone was available in the community. Results: One third (35.7%) of participants had recently received naloxone. Most who had received naloxone received two doses (72.1%), nasal naloxone (86.9%), and education about naloxone use (72.1%). Most currently had naloxone in their possession (either on their person or at home; 78.7%). One third (34.4%) believed naloxone was difficult to obtain in their community. Only half (56.7%) knew of multiple locations where they could get naloxone. The health department was the most commonly identified naloxone source (58.0%). Identifying multiple sources of naloxone was associated with being more likely to perceive that naloxone is easy to access. Discussion: Our results suggest that additional public health efforts are needed to make PWUO aware of the range of sources of naloxone in their communities in order to ensure easy and continued naloxone access to PWUO.

Preference for drugs containing fentanyl from a cross-sectional survey of people who use illicit opioids in three United States cities

Morales, K. B., Park, J. N., Glick, J. L., Rouhani, S., Green, T. C., & Sherman, S. G. (n.d.).

Publication year

2019

Journal title

Drug and alcohol dependence

Volume

204

10.1016/j.drugalcdep.2019.107547

Abstract

Abstract

Background: Death from fentanyl-related overdose is now a leading cause of mortality among US adults. We sought to characterize fentanyl preference among street-based people who use drugs (PWUD). Methods: Cross-sectional surveys were administered to PWUD (N = 308) who illicitly used heroin or prescription opioids in the prior six months. Recruitment occurred in 2017 in three US east coast cities with high overdose mortality: Baltimore, Boston, and Providence. Our main outcome was preference for fentanyl (yes/no); exposures included sociodemographics, drug use, and overdose history. Pearson's χ2, Shapiro-Wilk-Mann rank-sum tests, and tiered log-binomial regression determined sociodemographic and exposure-related factors associated with fentanyl preference. Results: Preference for nonmedical use of fentanyl was reported by 27% (n = 83) of the sample. Fentanyl preference was associated with non-Hispanic white race (adjusted risk ratio (ARR) = 1.68, 95% confidence interval (CI):1.18–2.40), daily illicit drug use (aRR = 2.2, CI:1.71–2.87), and overdose ≥1 year ago (aRR = 1.33, CI:1.18–1.50). Age (in decades; aRR = 0.77, CI:0.61–0.98) and overdose

Preventive malaria treatment among school-aged children in sub-Saharan Africa : a systematic review and meta-analyses

Cohee, L. M., Opondo, C., Clarke, S. E., Halliday, K. E., Cano, J., Shipper, A. G., Barger-Kamate, B., Djimde, A., Diarra, S., Dokras, A., Kamya, M. R., Lutumba, P., Ly, A. B., Nankabirwa, J. I., Njagi, J. K., Maiga, H., Maiteki-Sebuguzi, C., Matangila, J., Okello, G., … Chico, R. M. (n.d.).

Publication year

2020

Journal title

The Lancet Global Health

Volume

8

Issue

12

Page(s)

e1499-e1511

10.1016/S2214-109X(20)30325-9

Abstract

Abstract

Background: The burden of malaria infection in sub-Saharan Africa among school-aged children aged 5–15 years is underappreciated and represents an important source of human-to-mosquito transmission of Plasmodium falciparum. Additional interventions are needed to control and eliminate malaria. We aimed to assess whether preventive treatment of malaria might be an effective means of reducing P falciparum infection and anaemia in school-aged children and lowering parasite transmission. Methods: In this systematic review and two meta-analyses, we searched the online databases PubMed, Embase, Cochrane CENTRAL, and Clinicaltrials.gov for intervention studies published between Jan 1, 1990, and Dec 14, 2018. We included randomised studies that assessed the effect of antimalarial treatment among asymptomatic school-aged children aged 5–15 years in sub-Saharan Africa on prevalence of P falciparum infection and anaemia, clinical malaria, and cognitive function. We first extracted data for a study-level meta-analysis, then contacted research groups to request data for an individual participant data meta-analysis. Outcomes of interest included prevalence of P falciparum infection detected by microscopy, anaemia (study defined values or haemoglobin less than age-adjusted and sex-adjusted values), clinical malaria (infection and symptoms on the basis of study-specific definitions) during follow-up, and code transmission test scores. We assessed effects by treatment type and duration of time protected, and explored effect modification by transmission setting. For study-level meta-analysis, we calculated risk ratios for binary outcomes and standardised mean differences for continuous outcomes and pooled outcomes using fixed-effect and random-effects models. We used a hierarchical generalised linear model for meta-analysis of individual participant data. This study is registered with PROSPERO, CRD42016030197. Findings: Of 628 studies identified, 13 were eligible for the study-level meta-analysis (n=16 309). Researchers from 11 studies contributed data on at least one outcome (n=15 658) for an individual participant data meta-analysis. Interventions and study designs were highly heterogeneous; overall risk of bias was low. In the study-level meta-analysis, treatment was associated with reductions in P falciparum prevalence (risk ratio [RR] 0·27, 95% CI 0·17–0·44), anaemia (0·77, 0·65–0·91), and clinical malaria (0·40, 0·28–0·56); results for cognitive outcomes are not presented because data were only available for three trials. In our individual participant data meta-analysis, we found treatment significantly decreased P falciparum prevalence (adjusted RR [ARR] 0·46, 95% CI 0·40–0·53; p

Public support for reinvesting resources from enforcing drug possession to health-promoting alternatives : A nationally representative poll of adults in the United States

Tomko, C., Rouhani, S., LaSalle, L., & Sherman, S. G. (n.d.).

Publication year

2024

Journal title

International Journal of Drug Policy

Volume

126

10.1016/j.drugpo.2024.104370

Abstract

Abstract

Background: 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.

Public support for reinvesting resources from enforcing drug possession to health-promoting alternatives: A nationally representative poll of adults in the United States

Rouhani, S., Tomko, C., Rouhani, S., LaSalle, L., & Sherman, S. G. (n.d.).

Publication year

2024

Journal title

The International journal on drug policy

Volume

126

Page(s)

104370

Abstract

Abstract

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.

PWUD Experiences of Criminal Justice Reform : Enduring Tensions Between Policing and Harm Reduction in Baltimore, MD

Footer, K. H., Urquhart, G. J., Silberzahn, B., Rouhani, S., Weicker, N. P., Owczarzak, J., Park, J. N., Morris, M., & Sherman, S. G. (n.d.).

Publication year

2022

Journal title

Contemporary Drug Problems

10.1177/00914509221136913

Abstract

Abstract

In this paper we explore people who use drugs (PWUD) perceptions and experiences of drug-related law enforcement in a major U.S. city. Maryland recently implemented several harm reduction policies/interventions aiming to improve PWUD-police relationships, such as the Good Samaritan Law (GSL), intended to avoid criminalizing police encounters with PWUD in cases of overdose. PWUD, though most impacted by these efforts, are seldom included in the decision making process. Data collection occurred in Baltimore City, a majority-Black city with a history of structural racism, where high overdose fatalities necessitate collaborative interventions, but where over-policing and abusive practices have generated widespread community mistrust of police. Between October 2018 and December 2019, we conducted in-depth interviews with 20 PWUD in Baltimore City to understand their perspectives of policing and its impact on harm reduction practices (specifically willingness to seek overdose assistance) in the context of the GSL. PWUD reported ongoing police mistrust, which impacted their harm reduction practices and experiences of laws such as the GSL. Results question whether police, as first responders to overdose, can ever avoid criminalizing the encounter. Findings intend to guide future public health-law enforcement collaboration efforts in the context of the current de-policing debate.

Racial Disparities in Drug Arrest Before and After De Facto Decriminalization in Baltimore

Rouhani, S., Tomko, C., Silberzahn, B. E., Weicker, N. P., & Sherman, S. G. (n.d.).

Publication year

2023

Journal title

American journal of preventive medicine

10.1016/j.amepre.2023.04.004

Abstract

Abstract

Introduction: To mitigate the harms of arrest and incarceration on health and racial equity, jurisdictions are increasingly enacting reforms to decriminalize drug possession through prosecutorial discretion (de facto). Impacts on health outcomes rely on whether this policy can reduce exposure to the carceral system among people who use drugs; however, data evaluating effects on arrest are lacking. This study explores the possible impacts of Baltimore City's enactment of de facto decriminalization on arrests by race. Methods: Police and court records were used to explore the possible impacts of Baltimore City's de facto decriminalization on street arrests and (processed) arrests advancing through the courts among people who use drugs. Interrupted time series models were used to compare pre-policy (January 2018–March 2020) trends with post-policy (April 2020–December 2021) trends in arrests for possession of drugs/paraphernalia and estimate racial disparities in street arrests (Black versus other races). Analyses were performed in February–May 2022. Results: The policy was associated with a significant and immediate decline in street and processed arrests for possession, which was not seen for other crime categories. Although declines were concentrated in the Black community, disparities in arresting persisted after the policy. Conclusions: De facto decriminalization may be a promising strategy to reduce exposure to the carceral system, an established risk factor for overdose and other drug-related sequelae and a driver of racial disparities in the U.S. Further research is needed to elucidate the drivers of persisting racial disparities and disentangle policy effects from pandemic-related closures.

Racial resentment and support for decriminalization of drug possession in the United States

Rouhani, S., McGinty, E. E., Weicker, N. P., White, R. H., LaSalle, L., Barry, C. L., & Sherman, S. G. (n.d.).

Publication year

2022

Journal title

Preventive Medicine

Volume

163

10.1016/j.ypmed.2022.107189

Abstract

Abstract

Drug criminalization creates significant barriers to prevention and treatment of substance use disorders and racial equity objectives, and removal of criminal penalties for drug possession is increasingly being endorsed by health and justice advocates. We present empirical data estimating the share of U.S. adults who support eliminating criminal penalties for possession of all illicit drugs, and examine factors associated with public support. Data from the Johns Hopkins COVID-19 Civic Life and Public Health Survey, a probability-based nationally representative sample of 1222 U.S. adults, was collected from November 11–30, 2020. Support for decriminalizing drug possession was assessed overall and by sociodemographic factors and attitudes towards politics and race. Correlates of support were examined using multivariable logistic regression. Thirty-five percent of adults supported eliminating criminal penalties for drug possession in the U.S. In adjusted regression models, respondents who were younger or identified as politically liberal were more likely to support decriminalization relative to other groups, and respondents who were Hispanic or identified strongly with their religious beliefs were less likely to support decriminalization. Among white respondents, greater racial resentment was strongly associated with reduced support for drug decriminalization. Support for drug decriminalization varies considerably by beliefs about politics and race, with racial resentment among white Americans potentially comprising a barrier to drug policy reform. Findings can inform communication and advocacy efforts to promote drug policy reform in the United States.