Meet Dr. Hawre Jalal, a top researcher of North America’s drug overdose scourge
Posted on Thursday, June 2, 2022
By David McFadden
It’s difficult to overstate the heartache wrought by North America’s coast-to-coast drug overdose epidemic. Driven by the intertwined curse of synthetic opioids and methamphetamine, overdose mortality rates continue to surge. The catastrophic effects are unrelenting for many families and health systems.
Dr. Hawre Jalal, a physician by background and a health services researcher by training, specializes in teasing out important insights about this pressing public health issue.
The newest faculty member at the uOttawa Faculty of Medicine’s School of Epidemiology and Public Health, Dr. Jalal was most recently an Assistant Professor at the University of Pittsburgh, where he co-led a landmark research article that analyzed nearly four decades of U.S. drug overdose data that’s the subject of a special section in June’s International Journal of Drug Policy. Prior to that, he was a postdoctoral fellow at Stanford University.
Dr. Jalal talks to us about his academic research and expectations for his work at the Faculty of Medicine.
You’ve done a lot of important work and published widely in high-impact journals while at your previous post at Pitt. Tell us about some directions you see your research going in here at the uOttawa Faculty of Medicine? And other than matters of scale, do you see any notable differences between the defining addiction and drug overdose issues in Canada and those in the United States?
I am planning on studying the drivers of the drug and opioid epidemic in North America. Given the increasing difficulty of controlling illicitly manufactured drugs, I do not believe that the drivers of the modern drug epidemic in either Canada, the U.S. or Mexico can be studied in silo. This is especially true since the shift in illicit market supply from plant-based opioids (e.g., heroin) to the cheaper and more potent synthetic opioids (e.g., fentanyl) that are responsible for the majority of deaths in Canada and the U.S. nowadays.
Given the geographical proximity of Canada and the U.S., it is not surprising that overdose death rates are similar between the two countries. For example, during the first year of the COVID pandemic (April 2020 through March 2021), the opioid overdose death rate in Canada was 19 per 100,000 people , while in the U.S. it was only slightly higher at 23 per 100,000. What is striking is that the rate of overdose deaths nearly doubled in Canada compared to the pre-pandemic year vs. a 37% increase in the U.S. The factors driving the larger increase in overdoses in Canada compared to the U.S. are not known.
One area of particular interest is the disproportional impact of the epidemic on some populations at risk. In the U.S., the rate of substance use disorder and overdoses are greater among Native Americans, but the true impact is largely underreported mostly due to the structure of the health system in the U.S. Similarly, in Canada, First Nations people are disproportionally impacted with nearly threefold the risk of dying from opioids compared to their counterparts. I am particularly interested in addressing these disparities.
What would you consider the most surprising finding from your research work so far?
I think the most surprising finding is by far the near perfect exponential growth of overdoses in the U.S. for more than four decades – regardless of any particular drug or policy that may influence overdose deaths for a short period of time. There are only a handful of patterns that follow similar exponential trends, including Moore’s Law for increase in computer processor speed, bacterial growth, and nuclear reaction. For most of these we do have a good understanding of what the driving forces are. However, for the drug and opioid epidemic, we simply don’t – as highlighted in the special section of the International Journal on Drug Policy.
Can you talk a bit about how the COVID-19 pandemic appears to have impacted the deadly overdose epidemic, particularly with synthetic drugs?
At the beginning of the COVID-19 pandemic, experts were very concerned about the impact of COVID-19 on individuals with opioid and substance use disorder for many reasons, including social isolation, reduced access to treatment, economic impact of the pandemic, etc. Unfortunately, many of these worries are now realized with overdose deaths in Canada doubling and in the U.S. increasing by 37% above and beyond the long-term exponential growth. I have studied the COVID-19 patterns extensively since the start of the pandemic. I am planning on exploring this “collision” as data on the drug epidemic is starting to become available. At this time, it is too early to judge if COVID’s impact on substance use is short-term or if it will last long after the pandemic recedes.
Your research has shown that the drug overdose epidemic is hardly a new phenomenon, and the impact of the ongoing opioid crisis is widely known. Why are drug policies in North America still failing to effectively address this corrosive phenomenon?
What is important to understand is that the drug markets are highly dynamic with new synthetic drugs constantly being developed. These synthetic drugs impose a tremendous challenge to the traditional drug control policies. They are cheaper, easier to conceal and easier to synthesize compared to plant-based drugs.
In addition, most of our policies have been focused on medical interventions, focusing on increased treatment access and overdose reversal availability (e.g., Naloxone). While these interventions are highly important, their scale may not be sufficient to curb the growth curve. While every effort should be made to increase treatment access, we need to appreciate that the marginal increase is unlikely to change the trajectory of the drug and overdose epidemic. In addition, most of the focus of treatments and the overdose reversal drugs can only work against opioids, we currently do not have any real option for treatment of, or reversal of, other drugs such as methamphetamine.
Furthermore, producers of synthetic illicit drugs are more successful in evading control policies because unlike the plant-based drugs, the synthetic drugs are much easier to produce in small spaces with only a handful of chemists compared to large fields for plant-based drugs. All these factors make it especially challenging to fight the drug epidemic with the conventional approaches.
Anything you’d like to share about yourself that might be interesting to the wider uOttawa community?
I have a wide range of expertise in various fields including health economic evaluations, decision sciences and operations research. I enjoy borrowing methods from various disciplines to answer public health questions. I also enjoy working with large datasets and conducting many of my analyses on raw data to reveal patterns unknown before. I have collaborated with many Canadian agencies while still in the U.S., and I am looking forward to expanding my network while at uOttawa. I believe that uOttawa is strategically located to influence policies and decisions on important public health issues, such as the drug epidemic and COVID-19.