This is a transcript of the Spur of the Moment episode “The science of substance use with Dr. Nabarun Dasgupta.” It is provided as a courtesy and may contain errors.
Nabarun Dasgupta: The unexpected thing about transparency has been that it brings closure. It also is like once you do something and you post it publicly, you have kind of license to move on from it and on to something else.
Jocelyn Hittle: Welcome to Spur of the Moment, the podcast of Colorado State University’s Spur Campus in Denver, Colorado.
Nabarun Dasgupta: We often don’t give people who use drugs a real chance to participate in science because there’s like this paternalism that kicks in and excludes their voices from the science that affects their lives and I think that’s wrong. It was like an active process where I had to get over my past failure in order to make the right decisions and hire the right people, buy the right equipment and now I feel okay with it.
Jocelyn Hittle: On this podcast, we talk with experts in food, water, and health. And today I am joined by Nabarun Dasgupta, senior scientist and innovation fellow in public health at the University of North Carolina. Welcome Dr. Dasgupta.
Nabarun Dasgupta: Thanks Jocelyn. It’s nice to be here.
Jocelyn Hittle: It’s great to have you. As you know, on this podcast we are interested in having conversations with people who have careers in food, water, health, sustainability, things that are related CSU’s work at the Spur Campus here in Denver. And as a senior scientist and innovation fellow in public health, obviously you’re in the health space, but maybe you can tell us in a bit more detail about what does it mean to work in public health in the way that you do.
Nabarun Dasgupta: So, my passion is to tell true stories about health with numbers. And by profession, that makes me an epidemiologist. So epidemiologists have had a lot of visibility in the last two years as the ones who are trying to understand the transmission of COVID. And my job is to use those same methods that we have in infectious diseases to understand the spread of a virus and adapt that to the world of drugs of abuse. So street drugs like heroin and Oxycontin, things like that. So as an epidemiologist what I ended up doing is counting a lot of people, whether they’re sick, in hospitals or, mostly my focus is in overdose deaths. And so right now overdose deaths in the United States are a huge public health problem, maybe the second biggest problem after the Coronavirus. So in 2021, there were a 100,000 overdose deaths in the United States, one year alone. That’s an incredible toll and has gotten worse over the last two decades that I’ve been working on it.
Jocelyn Hittle: What you’re describing makes a lot of sense in terms of understanding the numbers. I’m assuming that a lot of what you do as an epidemiologist focused on drugs of abuse. Did I get that terminology right?
Nabarun Dasgupta: So the word abuse and the word addiction are falling out of favor because we understand now that there is a big variety of behaviors around how people use substances to alter their mood. Some of those things like coffee and nicotine have been around for a very long time. Those have different kinds of harms. Similarly, when we talk about heroin, that tends to be conceptually in a different bucket, right? But at the end of the day, it’s still a molecule going into a person, it’s still someone’s behavior and choice to use that substance and so whether it’s abuse or kind of using these different terms, lends a pejorative kind of view of it which often time clouds our objectivity as scientists. So I think of it more broadly.
Jocelyn Hittle: Okay, so substance use?
Nabarun Dasgupta: There we go, yes.
Jocelyn Hittle: So when we think about substance use I think a lot of people might be surprised at the way that you study it. I think of epidemiology as more about disease transmission. Is there a component of substance use that is similar to disease transmission or is it really more that it’s about the numbers as you said?
Nabarun Dasgupta: Ooh, that’s really interesting. So we think of drugs as a, it’s very similar to viruses in that it is a physical thing that gets transferred from person to person, right? And then it’s something that goes inside someone’s body and has an effect. I mean, it’s very kind of similar, but the mechanisms of transmission, the behaviors are different. So we can use a lot of the models that we have in infectious diseases to, as a starting point for understanding how drugs spread, how drug harms are kind of manifest in people who are using drugs. So, yeah, so there is a parallel there, but on a daily basis kind of what it looks like is running a lot of statistics on looking at national mortality data, looking at hospital admissions, things like that. So some of the work is big data. More recently the drug problem in the United States has really turned to street drugs. So heroin and something called fentanyl, which is another opioid like heroin but is a little bit more potent and has some different characteristics. And so right now the street drugs in the United States are more unpredictable and treacherous than they’ve ever been. So what we’ve had to do is adapt our techniques where before we could use large data sets when it was more of a prescription drug problem, and we would understand, you know, how much is being dispensed and things like that. Whereas now we have to, we’ve had to like create a new chemistry lab on our campus where we has treat drugs and figure out what’s actually in them. And using that information we can help people make better choices about what they put in their bodies, we help clinicians make decisions on how to treat patients who have come into the hospital with different, you know, rare side effects from drugs, and we spend a lot of time helping people who are trying to get into drug treatment, find the right place for them. So all of that kind of goes back to learning from the chemistry, kind of very physical hands on work instead of just the big data stuff.
Jocelyn Hittle: Hmm mm, thanks for that description. I think it to get at a little bit what a day in the life is like for someone who is in a role like yours although I think there aren’t that many people who are studying substance use in an epidemiological way. You know, is this an emerging field? How do you fit into sort of the epidemiological world?
Nabarun Dasgupta: Yeah, I, that’s an awesome question to hear because I’m so often in my bubble talking to other epi folks. So there are definitely, there’s definitely a whole bunch of us. I think the way we do things differently at my lab at UNC is that we really try to bring in people who have lived experience into the science. So whether you’re a pain patient or someone who uses drugs, like your input, what you’ve learned on the street, what you’ve learned as a patient is integral to our interpretation of chemistry and big data. And so I find that it’s much more rewarding to work directly with people who are impacted and it makes the science better at the end of the day and that’s kind of what we’re here for.
Jocelyn Hittle: Yeah, that’s interesting. I can imagine that it’s typical to have people who have been impacted by a disease involved in the research on that disease, whether it’s treatment or epidemiologically, right?
Nabarun Dasgupta: Yeah, it’s typical in like diabetes or cancer, right? It makes sense. But when, but there’s so much cultural baggage around drugs and how they “hijack your brain” and how they change behavior that we often don’t give people who use drugs a real chance to participate in science because there’s like this paternalism that kicks in and, you know, excludes their voices from the science that affects their lives and I think that’s wrong so we try to do better.
Jocelyn Hittle: Well and given everything you’ve said and what I know about the rates of substance use and challenges around opioid addiction in the US, the number of people that you’re talking about who are impacted is extraordinary.
Nabarun Dasgupta: It is. And isn’t it weird like if we, in our scientific papers, if the first few sentences of all these health papers are there’s, you know, thousands or millions of people affected by this condition, but then we managed to publish a paper without consulting a single one of them? That always seemed really odd to me that the people who are directly impacted aren’t more part of the science.
Jocelyn Hittle: As I said, you touched a little bit on kind of what a day in the life is like, but maybe you can tell us a little bit more about that. What does a week look like for you? What does it mean to be an innovation fellow and do the work you do?
Nabarun Dasgupta: It’s about 20 to 30 Zoom calls and…
Jocelyn Hittle: Well that’s okay. So it’s just like everyone else’s week.
Nabarun Dasgupta: Yes, exactly. I feel very fortunate ’cause I have an awesome team around me and we tend to attract folks who are independent thinkers. So we have folks who are running experiments in the lab being curious, like, you know, if this nasal swab has, you know, maybe this nasal swab has some residue of a chemical in it, maybe that is messing up our chromatograms or something like that. Or it’s hey, we just got this cool new data set. Maybe we can answer a better question this way and people will unpack those. So oftentimes it’s a lot of brainstorming new ideas and then really trusting the rest of the team to follow their intellectual curiosity and find new ways to answer tough questions. So, I’m at home, sitting at my home office a lot of the time, but there are students we work with and there’s some mentorship that goes on there. But best days are the days that I get to go out on the street and actually collect drug samples and talk to people who use drugs and go to syringe exchange programs or public health centers and drop-in centers. And, you know, it’s just a different pace. At times it feels slower than back to back Zooms but then when people come in looking for services, when someone comes in saying, hey, can you help me get some food and a driver’s license? Then it, the pace picks up and then the time just flies ’cause you’re there helping and making a real difference in someone’s life. And I’d rather spend so many more of those days than days writing code, but that’s kind of the way it is. Balance.
Jocelyn Hittle: So balancing more of the on the groundwork and the connection with the people who ultimately could benefit from a better understanding of substance use and writing code. Say more about the code part. What does that look like?
Nabarun Dasgupta: So these large data sets that we use often need a lot of processing to get to an inference, right, to get to… You know, it’s like you have, some of our data sets have 250 million people in them, right? And so to summarize those and say like, here’s the experience, here’s the average effect of something you need run a lot of statistics. And when you’re working with data that big you’re using multiple programming languages, oftentimes it’s R or SaaS data and Python, those are the four we usually use. And so writing code means, you know, processing the data so that it’s in the right format, making sure that, you know, the age is not coded in some weird format or doesn’t say a 1,000 years of someone’s age, things like that. But then we use those data to run statistical models or machine learning or natural language processing, other things where we can really summarize this vast experience that we have a representation of.
Jocelyn Hittle: So can you say a little bit more about the makeup of your lab? So folks who might not be familiar with how it works to be a researcher at a university might not understand sort of you have, you have a set of graduate students that are working with you. Do you also work with undergrads and maybe you can speak a little bit to the background of those students, ’cause it seems like you might want a diverse background to work in Dr. Dasgupta’s lab?
Nabarun Dasgupta: I think our lab is a bit unique in that we have, we have chemists who have master’s degrees and PhDs. We have epidemiologists and biostatisticians, some of whom are PhD level students and graduate students. We have undergraduates who help us with health communications research. And we also have physicians who work with us and project managers who are super, super important and finance people who are even, you know, are just so underappreciated but help run and manage our budgets and keep the, keep things going. So it’s a big team. Ours is called the Opioid Data Lab and it’s a collaboration between the University of North Carolina, the University of Kentucky and the University of Florida. And most of our work is funded by the US Food and Drug Administration and we advise FDA on issues of epidemiology as it relates to opioids, but we have other funders too. So it’s a really diverse crew, but in terms of undergrads, what, the part where we find that that working with undergrads is really, really helpful is in health communications because communicating how we do science, why we do science and the results is integral to our mission here.
Jocelyn Hittle: Maybe we can talk a little bit more about that communication piece. I know for one, there have been a number of different news and media outlets that have reached out to you. I know that communicating about your work is really important to you. So maybe you can talk a little bit more about your philosophy there. Why is communicating to the general population important and what’s your strategy around communicating science?
Nabarun Dasgupta: Yeah, so our motivation for communicating for, you know, going the extra mile and communicating science really has to do with the fact that we are at a state university. And we have an obligation to the folks who have invested in the university for generations to report back and to make our sciences accessible and transparent as possible. And that often means communicating at, in different ways to different audiences. So for the bio physicians, they wanna see equations, they wanna see code. For physicians they wanna see the bottom line and the P value in the study, you know, or like the statistical kind of output of the study. How does this affect their patients? For people on the ground, they wanna know kind of your motivations and have a lot of questions about research ethics. So it’s the same work, but you kind of repackage it for the right audiences. We have a couple of really fun strategies that we’ve adapted over the years. One is we work with the illustrator we have on staff. And so oftentimes we’ll do a study, but it’s a really hard concept for us to explain in words, because we’re so left brained as scientists, right? The left brain being the part of your brain, that’s orderly and logical. But oftentimes when you’re communicating, you want to tell a story and like have that story include the numbers that you have found, but have that really stick in someone’s mind. So in order to do that, we have an illustrator who for each of our studies will draw a small, you know, illustration that epitomizes the study. And so opioiddata.org is our website and you can see the work. Our artist’s name Brittain Peck. Another like visual thing, right, is like, is that everybody has a cell phone and photos and selfies are ubiquitous. And so the kind of the power of an image, like a photo kind of gets diluted because we use it all the time. On the other hand, when was the last time you had someone draw a portrait of you? Ah, it’s been, I’m sure it’s been a while.
Jocelyn Hittle: Never.
Nabarun Dasgupta: Like for all of us, right? So as a thank you gift to all our staff, we have our illustrator take a selfie of them from a, that they send us, you know, from a like happy moment, right? And he converts that, he hand draws it from that selfie into a avatar, into like a head, a portrait of you that we use on the website. But it’s just something that kind of unifies and personifies people. And it’s something that people can use as you know, in their social media or whatever. So we try to really kind of focus on the visuals but then the really cool thing I’ve learned about recently is advertising. And so there are, you know, advertisers are master communicators and people in public health are not. I work with a professor here named Allison Lazard who does randomized trials. Like, so they, she takes the advertising playbook and turns it to public health.
Jocelyn Hittle: Hmm mm.
Nabarun Dasgupta: And so, so if there’s like a message that we wanna get out, something about sugary drinks being bad for you, or, you know, a way to not, you know, maybe there’s a bad batch of drugs out there and we need to explain to people to stay away from them, but not like entice people to look for something that’s more potent. So we will do small, really quick studies where we randomize people to different messages and then gauge their reactions and using that we can figure out, you know, what the best language is to communicate. We were able to do this for the governor of North Carolina by request during the early stages of the COVID pandemic so that the messaging could be, you know, really evidence based. So it’s really effective and really elegant, you know?
Jocelyn Hittle: Yeah, I love that in part because I mean, I’m a big fan of interdisciplinary work. I think it helps everyone be smarter and more thoughtful about what they do when they are in the room with someone else who’s looking at their field through a different lens. And what a great example of honestly, what we hope to do at the CSU Spur Campus. Right our, all of our facilities are organized around themes, not around divisions or departments. So the idea is that we can bring together people from different fields to be in the same place and sort of look at each other’s work from different vantage points and figure out ways that they can collaborate. So I love that particular example, especially because you all did that collaborative work in service of improving public health.
Nabarun Dasgupta: Hmm mm.
Jocelyn Hittle: So can we talk about the pandemic for a few minutes?
Nabarun Dasgupta: Let’s talk about the pandemic.
Jocelyn Hittle: Let’s talk about the pandemic. You must be tired of talking about the pandemic. If you were to sort of reflect on where we are today, and we’re in here in February of 2022, what do you think about the pandemic? What happened? What could we have done differently? What could we have done better? Just in 10 words or less, just no pressure.
Nabarun Dasgupta: I think the biggest shift that we need to make right now is to is to accept that our risk tolerance is going to change. And this is something that I’ve been saying from day one in the pandemic is that the things that science tells us right now is going to be different from what we learn five months from now. We will have more information, the virus will change, people’s behaviors will change. There’s no like, you know, there’s maybe a handful of things you can do to, you know, “stay safe” from the virus. But at the end of the day, you know, something that seems really risky right now might feel totally commonplace in a few months and conversely things that seemed okay a few months ago, like when Omicron came around things, you know, we had to go backwards, right? So oftentimes we want absolutes, like here are things that I’m gonna do for the next, you know, what seemed like two months then turned into two years, right. But in reality, with all outbreaks, there’s an evolution in risk and understanding of the risk, but we don’t have a lot of language, a lot of, you know, models in where we talk explicitly about how our own concept of risk is changing and evolving and how that’s okay. So I would say we should go a little bit easier on ourselves and maybe not get caught up on the little things and understand that our tolerances are gonna change and that’s okay. You’re not right or wrong. It’s just the way it’s.
Jocelyn Hittle: Hmm. I do think that there is something about kind of general scientific literacy that is also important for us to acknowledge as part of what happened over the last two years.
Nabarun Dasgupta: You’re so right. You’re totally right. I think science literacy, I guess like explicit science literacy is really low. On the other hand, we use science in our everyday world all the time, right? Whether it’s, you know, whether it’s from our mobile phones, to the new materials that are in your kitchen, right? There’s new silicone and other things that we haven’t seen before. And so I think science literacy is important both for protecting ourselves from pandemics and being able to understand how information changes, but also as responsible consumers to understand and kind of, you know, what does it mean when an app is tracking you? What does it mean when, you know, maybe there’s a carcinogenic material, something that causes cancer, you know, maybe there’s a warning label on a product you’re buying. Like, is that a real risk? How important is that? So that decision making process of applying science to daily life I think is really missing.
Jocelyn Hittle: Absolutely. So I’d like to shift gears a little bit. Maybe you can tell our audience a little bit about how you got where you are, what was your journey to your current position?
Nabarun Dasgupta: So my journey is really like kind of intertwined with being an immigrant where I felt a lot of pressure from my parents to go into medicine, to be a doctor. So I was a pre-med in undergrad and it wasn’t, it didn’t feel like the right fit. I took a medical anthropology course and then realized that there was much more to health than just going into traditional medicine. And that course really changed my life. And so from there, I ended up kind of learning about public health and going on to get a master’s in public health and then went to work for a few years and then came back for a PhD in epidemiology and public health. The reason I came back for a PhD was that after my master’s, I found I was really good at critiquing other people’s work, but I was not very good at running my own numbers and my own studies. And so that was the kind of level up that I wanted to do by coming back to grad school for a PhD. And drugs were something that had always fascinated me, kind of just societally, right from, I think, “Trainspotting” and other movies like that at an early age and found that, you know, this was something that was fascinating to me. When I was trying to decide kind of what to do with my career, I remember getting an internship in Wyoming to do bioterrorism preparedness. And this was like, you know, in 2001 and I was living in Connecticut and I thought, oh, you know, this is gonna be cool. I’m gonna live on a ranch. This sounds awesome. But one of my professors pulled me aside and said, hey, there’s this other professor who’s going back to Maine, which is where I grew up and studying Oxycontin abuse. And it was like the second study ever done on Oxycontin abuse in the world. And so I was like, oh yeah, that sounds neat. And so I ended up going to Maine instead of Wyoming and really finding that that was unexpectedly what it felt like I was cut out to do.
Jocelyn Hittle: Yeah, so that’s interesting. I think when, in similar conversations with others, right, as we talk about what their journey is to their career path, there are frequently these moments that shift everything that you couldn’t predict. And I think if I were a young person and I’m looking at choosing career paths, that it feels a little bit scary to say, okay, I’m picking this thing and it’s gonna be this forever. And I think it’s great to just remind young people that there will be these moments that shift things and you’re not necessarily on a path that is 40 years of your professional life and never is there a deviation or variation from what you think that path that’s gonna be. So.
Nabarun Dasgupta: Yeah, and I think even, you know, even once you’re on a path, there may have been things along that path that scared you or that you thought you were really bad at. For me, it was organic chemistry and I failed orgo in college. But now because of the way that drugs in the United States have shifted I’ve to start my own chemistry lab on campus, right. So it took a lot of, I don’t know, it was like an active process where I had to get over my past failure in order to make the right decisions and hire the right people, buy the right equipment, things like that. And now I feel okay with it. The same with statistics. I was really bad at statistics but now, but it took like one really good course. And it wasn’t like I was learning advanced biostatistics. I was just like taking the intro course over and over again in different departments. And then finally found like, in the school of education here, a professor who like explained it in just this crystal way and I was like, okay, now I get it and now I’m not intimidated by stats anymore so.
Jocelyn Hittle: Yeah, that’s also a great story. I mean, I think I was the same about economics. It wasn’t until it was framed in a way that it was about forest management in my case that I, it really made sense to me. I do think there is something to be said for sticking with something that you think you’re never gonna get until you do, because you can, you will. You just need to maybe look at it from a slightly different angle.
Nabarun Dasgupta: Yep. And have, I mean, and that education teacher was really cool because she says, like, if she told us on the first day, she gave us like a few questions and said, here’s your right, here’s your learning style. And there was like six of ’em. And she was like, if you ever don’t understand something, I say, raise your hand and say like an improv show, can you repeat that in the style of blank learning style? And it was like, just this amazingly revelatory moment where you would see people raise their hand and she would just shift the order of words or just like, do these subtle changes, maybe bring in a different example and you could see people’s faces lighting up and that’s, you know, that kind of a professor is just life changing and…
Jocelyn Hittle: Wow, that’s incredible.
Nabarun Dasgupta: I wouldn’t have stayed in epidemiology if it wasn’t for her.
Jocelyn Hittle: Wow. Yeah so again, you know, another, a great example of sort of the people who are important. So what’s next, where are you headed next?
Nabarun Dasgupta: I mean, the street drug supply in the United States is changing so rapidly that keeping on top of what’s going and figuring out the harms from what’s out there is really kind of a full-time job for multiple people in my lab. So, yeah so I think we’re gonna be doing that. We’re moving a lot more towards open science and open science is this concept where everything you do in science should be open and accessible to other or people so that they can replicate what you do and also, so they don’t waste time writing the same code or doing the same experiments that they may not need to do. And so the way we operationalize this is to make our lab notebooks public. We do that both for chemistry in the lab, but also for statistics and writing code. But just know that there are tools that can, where you can like have code and hypotheses and run statistics and like capture graphs and have it all be one document that you can’t tamper with and that is something that we produce with each of our studies so that others can just take that and go to the next level, or which has definitely happened a couple of times. People point out mistakes we made. You know, sometimes it’s like a comma was in the wrong place and, in our code and that made it so that our statistic was wrong and people can catch that and fix it and that makes my work better. And it was a little bit intimidating at first, but then I realized I make mistakes all the time and it’s better if they’re caught and it’s better if people pointed out before something becomes health policy. I think for me, open science is part of my way to be honest about my science, but also to make sure that I’m not making big mistakes, ’cause the consequences are just too, just too great.
Jocelyn Hittle: Hmm mm, yeah. It’s a lot of responsibility. And that’s something that that’s very important to us also at Spur, the transparency is literally a part of our buildings, right? The there’s glass where you can watch the scientists work in their lab so, and they come mountain talk to kids and things like that. So, I think that transparency in on our side has meant one thing, but your description of your transparency is sort of next level, so appreciate that you all have adopted that.
Nabarun Dasgupta: Yeah. And the unexpected thing about transparency has been that it brings closure. It also it’s like once you do something and you post it publicly, you have kind of license to move on from it and onto something else. It’s kind of there, it’s done. And that’s been the unexpected kind of awesome thing about it. I feel like I can do new things once it’s public.
Jocelyn Hittle: Well, and it sounds like that is sort of constantly on your mind. What’s the next new thing? Whether it’s about an actual study or sort of how to communicate what you do or how to be responsive to what’s happening. So in the spirit of communicating about what it is you all do, where can people find more information about your work? Do you have some social media channels folks can follow?
Nabarun Dasgupta: Yes, we do. So opioidata.org is our main website. I’m on Twitter @NabarunD, N-A-B-A-R-U-N D And then we’ve just started a YouTube channel. We’ve only got a handful of videos, but we’re are trying to find ways to, you know, in two minutes communicate the results of our findings so that’s also at Opioid Data Lab.
Jocelyn Hittle: We’ll link to it in the show notes too. So now’s the time for this Spur of the Moment question.
Nabarun Dasgupta: I’ve been looking forward to this.
Jocelyn Hittle: Have you? Okay, so this one is a travel question. You’ve traveled a good bit. We’re gonna stay within the US. Is there somewhere within the US that you would go back to in a second, like your go-to place?
Nabarun Dasgupta: I think Utah always has called to me as a, just the grandiosity of the landscape and the variations and yeah, I love it out there. It just feels so different from the East Coast where I’ve spent most of my life. So I’d say Utah.
Jocelyn Hittle: Okay, and a related, second question is where’s your go-to at home?
Nabarun Dasgupta: Hmm. I mean the special place in North Carolina for me is called Ocracoke. It’s an island in the Outer Banks and it’s 30 miles out to sea and takes hours to get there. And there’s one tiny town and most of it’s a national seashore and it’s got great seafood. It’s the closest place that the Gulf Stream touches the United States and so we get amazing, amazing seafood and I’ll just go eat and eat seafood and be on the beach. That’s where I’d like to be.
Jocelyn Hittle: Yeah, I don’t blame you.
Nabarun Dasgupta: It was also the Black Beard the pirate’s hang out. So-
Jocelyn Hittle: Oh, okay. So a little historical piece to it as well.
Nabarun Dasgupta: Yeah. Black Beard’s like, people from his ship’s descendants actually still live and run the town.
Jocelyn Hittle: Oh.
Nabarun Dasgupta: So it’s-
Jocelyn Hittle: Okay, that is cool. That is really cool, yeah.
Nabarun Dasgupta: Its legit.
Jocelyn Hittle: All right. Well, thank you again, Dr. Dasgupta for being here on Spur of the Moment. We really appreciated your conversation and helping us to understand a little bit more about the work you do and the research on epidemiology of substance use. It’s really fascinating and appreciate your time and I hope that you will come and visit us in Denver sometime soon.
Nabarun Dasgupta: Thanks a lot. It’s great to be here.
Jocelyn Hittle: The Spur of the Moment podcast is produced by Peach Islander Productions and our theme music is by Ketsa. Please visit the show notes or links mentioned during today’s episode. We hope you’ll join us in two weeks for the next Spur of the Moment episode. Until then be well.