101
|
Degenhardt L, Grebely J, Stone J, Hickman M, Vickerman P, Marshall BDL, Bruneau J, Altice FL, Henderson G, Rahimi-Movaghar A, Larney S. Global patterns of opioid use and dependence: harms to populations, interventions, and future action. Lancet 2019; 394:1560-1579. [PMID: 31657732 PMCID: PMC7068135 DOI: 10.1016/s0140-6736(19)32229-9] [Citation(s) in RCA: 399] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022]
Abstract
We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3-47·9 million) and 109 500 people (105 800-113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes-eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.
Collapse
Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Jason Grebely
- Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Succursale Centre-Ville, Montreal, QC, Canada
| | | | | | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| |
Collapse
|
102
|
Palamar JJ, Acosta P, Sutherland R, Shedlin MG, Barratt MJ. Adulterants and altruism: A qualitative investigation of "drug checkers" in North America. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:160-169. [PMID: 31610451 DOI: 10.1016/j.drugpo.2019.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND "Drug checking" has become a common harm reduction method used to test illicit substances, such as ecstasy, for purity and/or the presence of adulterants. Formal drug-checking services have been operating for decades, and the use of personal reagent test kits appears to be relatively common; however, little attention has been devoted to understanding the role and broader experiences of 'drug-checkers' (i.e., people who test their own and/or other people's substances). As such, it remains unknown who is engaging in this practice, their motivations for drug-checking, and what barriers they may experience. We addressed this research gap by interviewing people who check drugs about their experiences, with a goal of better understanding drug checking practices. METHODS We conducted in-depth interviews with 32 adults in North America who reported testing drugs. Coding was conducted in an inductive manner and thematic analysis was used to identify relevant themes. RESULTS Over half (56.2%) of our sample was affiliated with a drug checking organization. Among non-affiliated checkers (43.8%), the majority (57.1%) tested for friends, 21.4% tested only for themselves, and 21.4% were people who sold drugs and tested for their clients. Motivations were driven largely by altruism, described by checkers as wanting to protect their peers from exposure to adulterants. People interviewed who sold drugs were altruistic in the same manner. Barriers to checking-particularly at nightclubs and festivals-included perceived illegality of test kits and denied approval to test drugs at venues, although many checkers circumvented this barrier by checking drugs without such approval. CONCLUSIONS Drug checkers in North America seek to educate people who use drugs about the risk of exposure to unexpected substance types, but they face various barriers. Policy change could help ensure that these potentially life-saving services can be provided without fear of fines and/or criminal prosecution.
Collapse
Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, Room 1752, New York, NY 10016, USA; Center for Drug Use and HIV/HCV Research, NYU College of Global Public Health, New York, NY, USA.
| | - Patricia Acosta
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, Room 1752, New York, NY 10016, USA
| | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michele G Shedlin
- Center for Drug Use and HIV/HCV Research, NYU College of Global Public Health, New York, NY, USA
| | - Monica J Barratt
- Social and Global Studies Centre, RMIT University, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| |
Collapse
|
103
|
Davis CS, Carr DH, Samuels EA. Paraphernalia Laws, Criminalizing Possession and Distribution of Items Used to Consume Illicit Drugs, and Injection-Related Harm. Am J Public Health 2019; 109:1564-1567. [PMID: 31536408 DOI: 10.2105/ajph.2019.305268] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The United States remains in the grip of an unprecedented epidemic of drug-related harm. Infections of HIV, hepatitis C, and endocarditis related to lack of access to new syringes and subsequent syringe sharing among people who inject drugs have increased alongside a surge in opioid overdose deaths.Overwhelming evidence shows that using a new syringe with every injection prevents injection-related blood-borne disease transmission. Additionally, there is promising research suggesting that the distribution of fentanyl test strips to people who inject drugs changes individuals' injection decisions, which enables safer drug use and reduces the risk of fatal overdose. However, laws prohibiting the possession of syringes and fentanyl test strips persist in nearly every state.The full and immediate repeal of state paraphernalia laws is both warranted and needed to reduce opioid overdose death and related harms. Such repeal would improve the health of people who inject drugs and those with whom they interact, reducing the spread of blood-borne disease and fatal overdose associated with infiltration of illicitly manufactured fentanyl into the illicit drug supply. It would also free up scarce public resources that could be redirected toward evidence-based approaches to reducing drug-related harm.
Collapse
Affiliation(s)
- Corey S Davis
- Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Derek H Carr
- Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Elizabeth A Samuels
- Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| |
Collapse
|
104
|
Bach H, Jenkins V, Aledhaim A, Moayedi S, Schenkel SM, Kim HK. Prevalence of fentanyl exposure and knowledge regarding the risk of its use among emergency department patients with active opioid use history at an urban medical center in Baltimore, Maryland. Clin Toxicol (Phila) 2019; 58:460-465. [PMID: 31475588 DOI: 10.1080/15563650.2019.1657583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Overdose deaths from fentanyl and its analogs have increased significantly since 2013. There are limited data regarding the prevalence of fentanyl exposure among emergency department (ED) patients with active opioid use.Methods: We conducted a cross-sectional study at an urban hospital from May 20 to July 30, 2018. A convenience sample of adult ED patients with active opioid use, defined as opioid use within seven days prior to ED visit, were enrolled. Rapid Response® Single Drug Test Strip (BTNX Inc., Markham, Canada) was used to detect fentanyl in urine samples. Information on demographic, substance use history, and knowledge of fentanyl was obtained using a brief survey tool. Our primary outcome was the prevalence of fentanyl exposure; secondary outcomes included patients' knowledge regarding potency, risk of overdose death from fentanyl and intentional purchase of fentanyl.Results: During our study period, 451 patients reported active substance use. Of these, 208 reported active opioid use and 165 consented for the study. The median age was 49 years [interquartile range: 38, 57] and 77.0% (n = 127) were male; 42 participants (25.5%) presented to ED after an acute overdose event. Heroin was the preferred opioid of use in 90.8% of the participants, primarily via intranasal route (64.6%). Polysubstance use was reported in 98.8%, most commonly with cocaine (57.6%; n = 95). Fentanyl was detected in 104 out of 129 urine samples tested (80.6%). 84.2% (n = 139) identified fentanyl as highly potent and 85.5% (n = 141) recognized highest risk of death in fentanyl overdose. A larger proportion of non-overdose participants intentionally purchased fentanyl (34.1%; n = 42) compared to the overdose group (16.7%, n = 7; p = .04).Conclusions: The majority of ED patient with active opiate use were exposed to fentanyl while one in three participants intentionally purchased fentanyl despite their awareness of its potency and the high-risk of death from overdose.
Collapse
Affiliation(s)
- H Bach
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - V Jenkins
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - A Aledhaim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Moayedi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S M Schenkel
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - H K Kim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
105
|
Taha S, Maloney-Hall B, Buxton J. Lessons learned from the opioid crisis across the pillars of the Canadian drugs and substances strategy. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:32. [PMID: 31426814 PMCID: PMC6700784 DOI: 10.1186/s13011-019-0220-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/07/2019] [Indexed: 01/19/2023]
Abstract
Background Canada is facing an urgent challenge to reduce the harms associated with opioids: from January 2016 to December of 2018, more than 11,500 individuals lost their lives due to opioid related harms. This review examines responses to the opioid crisis thus far, the lessons learned from these initiatives and the knowledge gaps that still need to be addressed across the four pillar model adopted by the CDSS. Methods A search of peer-reviewed literature was conducted in PubMed and PsycNet, and grey literature was retrieved from reputable substance use and health organizations to determine responses to the opioid crisis and related outcomes between 2013 and 2019. Findings related to actions, outcomes and unintended consequences across the categories of prevention, treatment, harm reduction, enforcement and the evidence base were included and synthesized into a narrative review on lessons learned. Results The opioid crisis is a result of multiple, complex interrelated factors. Many physicians may not feel competent to appropriately treat pain and/or addiction. Pushes for opioid deprescribing have resulted in some individuals using illicit opioids as treatment. A range of effective and accessible pharmacological and psychological treatments are still required. When regulations are barriers, unsanctioned actions, such as overdose prevention sites, may be enacted by individuals to respond to urgent public health needs. A nimble response with evolving enforcement perspectives can aid individuals experiencing harms from opioid use. Conclusions There is no one size fits all response to this crisis, and consideration should be given to the unique needs of different communities and populations, as well as the broader impact of harms on families, communities, and society. A situation so multifaceted requires both immediate and long-term strategies implemented concurrently in order to address the differing and on-going needs of Canadians experiencing opioid harms. The expertise of individuals and families affected by the opioid crisis must be included in consultations and decisions related to different strategies, to ensure responses are not stigmatizing, that they will be effective and acceptable and that unintended consequences are quickly recognized and mitigated.
Collapse
Affiliation(s)
- Sheena Taha
- Canadian Centre on Substance Use and Addiction, 500-75 Albert Street, Ottawa, ON, K1P 5E7, Canada.
| | - Bridget Maloney-Hall
- Canadian Centre on Substance Use and Addiction, 500-75 Albert Street, Ottawa, ON, K1P 5E7, Canada
| | - Jane Buxton
- British Columbia Centre for Disease Control, 655 W 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada
| |
Collapse
|
106
|
Valente H, Martins D, Carvalho H, Pires CV, Carvalho MC, Pinto M, Barratt MJ. Evaluation of a drug checking service at a large scale electronic music festival in Portugal. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:88-95. [PMID: 31398488 DOI: 10.1016/j.drugpo.2019.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 06/01/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Drug checking services are being implemented in recreational settings across the world, however these projects are frequently accused of a lack of evidence concerning their impact on people who use drugs. This paper describes the implementation of a drug checking service at the Boom Festival 2016 and explores the impact of this service on its users' behavioural intentions. METHODS 753 drug samples were submitted to the drug checking service for chemical analysis. All drug checking users were invited to fill a pre-analysis and a post-analysis questionnaire. 310 pre- and post-analysis questionnaires answered by users of the service were successfully matched. RESULTS When the test results were "unexpected" (N = 86), 94.3% of the service users reported that they would not to take the drug. When the test result indicated the sample contained "the expected substance plus adulterants" (N = 41) 32% of users stated they would not take it. When the test result was "only the expected substance" (N = 370), as anticipated, 98% of the participants reported they would take it. There was a statistically significant association between users' behavioural intentions and drug-checking result (χ2(2) = 350,042, p < .001). CONCLUSIONS These results support the hypothesis that providing drug checking services in large-scale festivals helps users to better manage their drug use and deal with drug adulteration. The data corroborates the supposition that when provided with objective information about the content of their drugs, some users consider health protecting behaviours. Additionally, these results can contribute to the design of tailored harm reduction interventions that take into consideration clients' characteristics, profiles and motivations.
Collapse
Affiliation(s)
- Helena Valente
- Faculty of Psychology and Educational Sciences of the Porto University, Portugal; Kosmicare Association, Portugal; CINTESIS. Centre for Health Technology and Services Research, Portugal.
| | - Daniel Martins
- Kosmicare Association, Portugal; CIQUP. Department of Chemistry and Biochemistry, Faculty of Sciences of the Porto Univsersity of Porto, Portugal
| | - Helena Carvalho
- CPUP. Centre for Psychology of the University of Porto, Portugal; inED. Centre for Research and Innovation in Education, Portugal
| | - Cristiana Vale Pires
- Kosmicare Association, Portugal; Faculty of Education and Psychology of the Portuguese Catholic University, Portugal; CRIA. Centre for Research in Anthropology, Portugal
| | - Maria Carmo Carvalho
- Kosmicare Association, Portugal; CRIA. Centre for Research in Anthropology, Portugal
| | - Marta Pinto
- Faculty of Psychology and Educational Sciences of the Porto University, Portugal; CINTESIS. Centre for Health Technology and Services Research, Portugal; Faculty of Medicine of the Porto University, Portugal
| | - Monica J Barratt
- Social and Global Studies Centre, RMIT University, Australia; National Drug and Alcohol Research Centre, Australia
| |
Collapse
|
107
|
Daniulaityte R, Carlson RR, Juhascik MP, Strayer KE, Sizemore IE. Street fentanyl use: Experiences, preferences, and concordance between self-reports and urine toxicology. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:3-9. [PMID: 31146200 DOI: 10.1016/j.drugpo.2019.05.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 04/25/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Conducted in Dayton, Ohio, the study aims to characterize user knowledge and experiences with non-pharmaceutical fentanyl-type drugs (NPFs) and compare self-reports with urine toxicology for NPFs and heroin. METHODS Between May 2017-January 2018, 60 individuals who self-reported heroin/NPF use were interviewed using structured questionnaire on socio-demographics, NPF and other drug use practices. Unobserved urine samples were collected and analyzed using: 1) liquid-chromatography-tandem mass spectrometry (LC-MS/MS)-based method (Toxicology lab) to identify 34 fentanyl analogues, metabolites, and other synthetic opioids; 2) immunoassay-based method to screen for opiates (heroin). Sensitivity, specificity and Cohen's kappa were calculated to assess agreement between self-reports and urine toxicology. RESULTS The sample was 52% female, and over 90% white. Almost 60% reported preference for heroin, and 40% for NPF. Participants endorsed a number of ways of distinguishing heroin from NPF, including appearance (88.3%), effects (76.7%), taste (55%), and information provided by dealers (53.3%). Almost 80% felt confident they could distinguish heroin from NPF, but knowledge about fentanyl analogues was limited. LC-MS/MS testing identified 8 types of NPFs. Over 88% tested positive for NPFs, including 86% fentanyl, 48% carfentanil, 42% acetyl fentanyl. About 47% screened positive for opiates/heroin, and all of them were also positive for NPFs. When comparing self-reported use of NPF to urine toxicology, sensitivity and specificity were relatively high (84% and 83.3%, accordingly), while Cohen's Kappa was 0.445, indicating fair agreement. Sensitivity and specificity were lower for heroin (77.8% and 50.0%, accordingly), and Cohen's Kappa was 0.296, indicating low agreement between self-reports of heroin use and urine toxicology. DISCUSSION Nearly 90% of the study participants tested positive for NPF-type drugs. Participants were more likely to over-report heroin use and underreport NPF use. The majority had little knowledge about fentanyl analogues. Study findings will inform development of novel harm reduction approaches to reduce overdose mortality.
Collapse
Affiliation(s)
- Raminta Daniulaityte
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, 3171 Research Blvd, Kettering, OH 45420, United States.
| | - Robert R Carlson
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, 3171 Research Blvd, Kettering, OH 45420, United States.
| | - Matthew P Juhascik
- Montgomery County Coroner's Office/Miami Valley Regional Crime Lab (MCCO/MVRCL), 361 W Third St, Dayton, OH 45402, United States.
| | - Kraig E Strayer
- Department of Chemistry, Wright State University, 202 Oelman Hall, Dayton, OH 45435, United States.
| | - Ioana E Sizemore
- Department of Chemistry, Wright State University, 202 Oelman Hall, Dayton, OH 45435, United States.
| |
Collapse
|
108
|
Bardwell G, Boyd J, Arredondo J, McNeil R, Kerr T. Trusting the source: The potential role of drug dealers in reducing drug-related harms via drug checking. Drug Alcohol Depend 2019; 198:1-6. [PMID: 30856370 PMCID: PMC6467706 DOI: 10.1016/j.drugalcdep.2019.01.035] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Drug checking technologies (DCTs) have been implemented as a response to the ongoing opioid overdose epidemic. We examined the level of trust people who use drugs (PWUD) have in their drug dealers as well as their perspectives on the potential for drug dealers to use DCTs to provide knowledge of drug contents to their customers. METHODS We conducted one-to-one qualitative semi-structured interviews with 20 PWUD in Vancouver, Canada's Downtown Eastside. Participants were purposively recruited from ongoing cohort studies of PWUD and were required to currently be using stimulants and/or opioids. RESULTS Most participants discussed having a high level of trust for their drug dealers based on length of relationships, drug supply consistencies, and communication. Given this, participants did not identify drug checking as a priority. However, participants discussed a lower level of trust when buying drugs from an unfamiliar source. Participants also discussed how DCTs would provide knowledge to drug dealers about drug contents and how communicating test results to customers could be a risk reduction measure. Participants described privacy concerns that drug dealers might experience as well as the lack of concern that some drug dealers have about their drug supply. CONCLUSIONS Future drug checking programming should consider ways to engage drug dealers to test their supplies and develop communication strategies to more accurately inform PWUD of drug contents and avert risks associated with using them. Additionally, drug policies that address the effects of criminalization should be considered to lessen potential barriers to DCT use by drug dealers.
Collapse
Affiliation(s)
- Geoff Bardwell
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Jade Boyd
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Jaime Arredondo
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Ryan McNeil
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| |
Collapse
|
109
|
Davis CS. Commentary on Neale et al. (2019): Foregrounding the competency, expertise and rights of people who use drugs. Addiction 2019; 114:719-720. [PMID: 30854746 DOI: 10.1111/add.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Corey S Davis
- Network for Public Health Law, Edina, MN, USA.,Brody School of Medicine, East Carolina University, Greenville, NC, USA
| |
Collapse
|
110
|
Goldman JE, Waye KM, Periera KA, Krieger MS, Yedinak JL, Marshall BDL. Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: a qualitative study. Harm Reduct J 2019; 16:3. [PMID: 30621699 PMCID: PMC6325714 DOI: 10.1186/s12954-018-0276-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/26/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In 2016, drug overdose deaths exceeded 64,000 in the United States, driven by a sixfold increase in deaths attributable to illicitly manufactured fentanyl. Rapid fentanyl test strips (FTS), used to detect fentanyl in illicit drugs, may help inform people who use drugs about their risk of fentanyl exposure prior to consumption. This qualitative study assessed perceptions of FTS among young adults. METHODS From May to September 2017, we recruited a convenience sample of 93 young adults in Rhode Island (age 18-35 years) with self-reported drug use in the past 30 days to participate in a pilot study aimed at better understanding perspectives of using take-home FTS for personal use. Participants completed a baseline quantitative survey, then completed a training to learn how to use the FTS. Participants then received ten FTS for personal use and were asked to return 2-4 weeks later to complete a brief quantitative and structured qualitative interview. Interviews were transcribed, coded, and double coded in NVivo (Version 11). RESULTS Of the 81 (87%) participants who returned for follow-up, the majority (n = 62, 77%) used at least one FTS, and of those, a majority found them to be useful and straightforward to use. Positive FTS results led some participants to alter their drug use behaviors, including discarding their drug supply, using with someone else, and keeping naloxone nearby. Participants also reported giving FTS to friends who they felt were at high risk for fentanyl exposure. CONCLUSION These findings provide important perspectives on the use of FTS among young adults who use drugs. Given the high level of acceptability and behavioral changes reported by study participants, FTS may be a useful harm reduction intervention to reduce fentanyl overdose risk among this population. TRIAL REGISTRATION The study protocol is registered with the US National Library of Medicine, Identifier NCT03373825, 12/24/2017, registered retrospectively. https://clinicaltrials.gov/ct2/show/NCT03373825?id=NCT03373825&rank=1.
Collapse
Affiliation(s)
- Jacqueline E Goldman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Katherine M Waye
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Kobe A Periera
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Maxwell S Krieger
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
| |
Collapse
|