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Tsang VWL, Wong JS, Westenberg JN, Ramadhan NH, Fadakar H, Nikoo M, Li VW, Mathew N, Azar P, Jang KL, Krausz RM. Systematic review on intentional non-medical fentanyl use among people who use drugs. Front Psychiatry 2024; 15:1347678. [PMID: 38414500 PMCID: PMC10896833 DOI: 10.3389/fpsyt.2024.1347678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 02/29/2024] Open
Abstract
Objectives Fentanyl is a highly potent opioid and has, until recently, been considered an unwanted contaminant in the street drug supply among people who use drugs (PWUD). However, it has become a drug of choice for an increasing number of individuals. This systematic review evaluated intentional non-medical fentanyl use among PWUD, specifically by summarizing demographic variance, reasons for use, and resulting patterns of use. Methods The search strategy was developed with a combination of free text keywords and MeSH and non-MeSH keywords, and adapted with database-specific filters to Ovid MEDLINE, Embase, Web of Science, and PsychINFO. Studies included were human studies with intentional use of non-medical fentanyl or analogues in individuals older than 13. Only peer-reviewed original articles available in English were included. Results The search resulted in 4437 studies after de-duplication, of which 132 were selected for full-text review. Out of 41 papers included, it was found that individuals who use fentanyl intentionally were more likely to be young, male, and White. They were also more likely to have experienced overdoses, and report injection drug use. There is evidence that fentanyl seeking behaviours are motivated by greater potency, delay of withdrawal, lower cost, and greater availability. Conclusions Among PWUD, individuals who intentionally use fentanyl have severe substance use patterns, precarious living situations, and extensive overdose history. In response to the increasing number of individuals who use fentanyl, alternative treatment approaches need to be developed for more effective management of withdrawal and opioid use disorder. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021272111.
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Affiliation(s)
- Vivian W. L. Tsang
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - James S.H. Wong
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jean N. Westenberg
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Noor H. Ramadhan
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Hasti Fadakar
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Victor W. Li
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Nick Mathew
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Burnaby, BC, Canada
| | - Pouya Azar
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Kerry L. Jang
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Reinhard M. Krausz
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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2
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Moon KJ, Whitehead HD, Trinh A, Hasenstab KA, Hayes KL, Stanley D, Carter B, Barclay R, Lieberman M, Nawaz S. Enhancing drug checking services for supply monitoring: perspectives on implementation in syringe service programs in the USA. Harm Reduct J 2024; 21:11. [PMID: 38218980 PMCID: PMC10788002 DOI: 10.1186/s12954-023-00924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Shifts in the US drug supply, including the proliferation of synthetic opioids and emergence of xylazine, have contributed to the worsening toll of the overdose epidemic. Drug checking services offer a critical intervention to promote agency among people who use drugs (PWUD) to reduce overdose risk. Current drug checking methods can be enhanced to contribute to supply-level monitoring in the USA, overcoming the selection bias associated with existing supply monitoring efforts and informing public health interventions. METHODS As a group of analytical chemists, public health researchers, evaluators, and harm reductionists, we used a semi-structured guide to facilitate discussion of four different approaches for syringe service programs (SSPs) to offer drug checking services for supply-level monitoring. Using thematic analysis, we identified four key principles that SSPs should consider when implementing drug checking programs. RESULTS A number of analytical methods exist for drug checking to contribute to supply-level monitoring. While there is likely not a one-size-fits-all approach, SSPs should prioritize methods that can (1) provide immediate utility to PWUD, (2) integrate seamlessly into existing workflows, (3) balance individual- and population-level data needs, and (4) attend to legal concerns for implementation and dissemination. CONCLUSIONS Enhancing drug checking methods for supply-level monitoring has the potential to detect emerging threats in the drug supply and reduce the toll of the worsening overdose epidemic.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heather D Whitehead
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Anne Trinh
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Kathleen L Hayes
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | | | | | | | - Marya Lieberman
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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3
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Perdue T, Carlson R, Daniulaityte R, Silverstein SM, Bluthenthal RN, Valdez A, Cepeda A. Characterizing prescription opioid, heroin, and fentanyl initiation trajectories: A qualitative study. Soc Sci Med 2024; 340:116441. [PMID: 38061222 DOI: 10.1016/j.socscimed.2023.116441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 01/23/2024]
Abstract
We understand the current crisis of overdose deaths to be driven by widespread opioid use, characterized by distinct 'waves' of drug use. The first wave was driven by prescription opioids, the second by heroin, and the third by illicit, non-pharmaceutical fentanyl and fentanyl analogues (henceforth, fentanyl). The purpose of this study is to describe opioid initiation within each of the three waves from the perspective of people who use illicit opioids, with a focus on emerging pathways into fentanyl use. The authors recruited sixty people reporting past-30-day illicit opioid use in Dayton, Ohio. Participants completed a brief survey and a semi-structured in-depth qualitative interview, conducted from March to November 2020 with a total of 13 in-person and 47 virtual interviews. The qualitative interviews were transcribed in their entirety and analyzed thematically using NVivo 12. We noted supply-side changes as influencing trajectories in all three waves. However, we also noted differences in the experiences of prescription opioid and heroin initiation, with these trajectories influenced by pharmacological effects, pain management, curiosity, intergenerational use, pricing, and peers. In comparison, most participants were unaware that they were initiating fentanyl, and many reported overdosing with their first use of fentanyl. We identified a trajectory into fentanyl with limited to no prior heroin use among a few participants. The increased risk of overdose with initiation into fentanyl use further emphasizes the need for an expansion of naloxone distribution and the implementation of more comprehensive measures, such as overdose prevention centers, drug testing, and a safer supply. Further research on the dynamics of the ongoing overdose death crisis in the era of fentanyl and the 4th wave of the overdose crisis is critical in developing responsive prevention and intervention strategies.
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Affiliation(s)
- Tasha Perdue
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, United States.
| | - Robert Carlson
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Raminta Daniulaityte
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Sydney M Silverstein
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, United States
| | - Avelardo Valdez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Alice Cepeda
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
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4
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Rigg KK, Kusiak ES. Perceptions of fentanyl among African Americans who misuse opioids: implications for risk reduction. Harm Reduct J 2023; 20:179. [PMID: 38110965 PMCID: PMC10729467 DOI: 10.1186/s12954-023-00915-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Fentanyl is a powerful synthetic opioid that is 50 times more powerful than heroin and has become ubiquitous in the illicit drug supply in the USA. Studies show that among people who use drugs, fentanyl is sometimes viewed as a desirable substance due to its high potency and low cost, while others have an unfavorable perception because of its association with overdose. Unfortunately, studies on the perceptions of fentanyl are relatively rare and existing studies tend to rely on samples with little African American representation. The objective of this study, therefore, was to identify and describe perceptions of fentanyl among African Americans who misuse opioids, while capturing their motivations for seeking out or avoiding fentanyl. METHODS In-depth interviews (n = 30) were conducted with a sample of African American adults who misuse opioids in Southwest Florida between August 2021 and February 2022. Audiotapes of interviews were transcribed, coded, and thematically analyzed. RESULTS Analyses revealed the presence of three subtypes of fentanyl-related perceptions: (1) fentanyl as an avoided adulterant, (2) fentanyl as a tolerated adulterant, and (3) fentanyl as a drug of choice. CONCLUSIONS These findings show that African Americans' perceptions of fentanyl are not monolithic and suggest the distribution of fentanyl test strips and naloxone may be an effective risk reduction strategy. Given that most studies on fentanyl rely on quantitative data from drug seizures and death certificates, this study uniquely contributes to the literature by capturing the voices of African Americans who use drugs.
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Affiliation(s)
- Khary K Rigg
- Department of Mental Health Law and Policy, University of South Florida, 13301 Bruce B. Downs Blvd, Tampa, FL, 33612, USA.
| | - Ethan S Kusiak
- Department of Mental Health Law and Policy, University of South Florida, 13301 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
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5
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Abadie R. "I don't want to die": a qualitative study of coping strategies to prevent fentanyl-related overdose deaths among people who inject drugs and its implications for harm reduction policies. Harm Reduct J 2023; 20:75. [PMID: 37316884 PMCID: PMC10264884 DOI: 10.1186/s12954-023-00805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Fentanyl and fentanyl-related analogues are the main drivers of overdose death in the USA, particularly among people who inject drugs (PWID). Despite the fact that non-Hispanic whites exhibit higher population rates of synthetic opioid mortality, overdose deaths have increased among African American and Latinos in urban areas. Yet little attention has been paid to the introduction of fentanyl among rural PWID in Puerto Rico. METHODS We conducted N = 38 in-depth interviews with PWID in rural Puerto Rico to document participants' experiences of injection drug use after the arrival of fentanyl and the strategies they implemented to manage overdose death risks. RESULTS Participants suggest that the arrival of fentanyl in large scale happened after Hurricane Maria in 2017; this coincided with a dramatic increase in overdose episodes and deaths. Fear of overdose deaths motivated some participants to substitute intravenous drug use for other forms of substance use or to seek MOUD. PWID that continued injection use resorted to conducting "hit tests," avoiding injecting alone, using naloxone, and employing fentanyl testing strips. CONCLUSIONS While overdose deaths would have been higher without participants' willingness to adopt harm-reduction strategies, this paper illustrates the limits of these policies to address the current epidemic of fentanyl-related overdose deaths among this population. More studies are needed to understand how health disparities shape overdose risks for minority populations. However, major policy changes, in particular the revision of the harmful role of the War on Drugs and the termination of failed neoliberal economic policies that contribute to deaths of despair, should be addressed if we are to make a dent in this epidemic.
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Affiliation(s)
- R Abadie
- Department of Anthropology, University of Nebraska-Lincoln, 839 Oldfather Hall, Lincoln, NE, 68588, USA.
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Kasson E, Filiatreau LM, Kaiser N, Davet K, Taylor J, Garg S, El Sherief M, Aledavood T, De Choudhury M, Cavazos-Rehg P. Using Social Media to Examine Themes Surrounding Fentanyl Misuse and Risk Indicators. Subst Use Misuse 2023; 58:920-929. [PMID: 37021375 PMCID: PMC10464934 DOI: 10.1080/10826084.2023.2196574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background: Opioid misuse is a crisis in the United States, and synthetic opioids such as fentanyl pose risks for overdose and mortality. Individuals who misuse substances commonly seek information and support online due to stigma and legal concerns, and this online networking may provide insight for substance misuse prevention and treatment. We aimed to characterize topics in substance-misuse related discourse among members of an online fentanyl community. Method: We investigated posts on a fentanyl-specific forum on the platform Reddit to identify emergent substance misuse-related themes potentially indicative of heightened risk for overdose and other adverse health outcomes. We analyzed 27 posts and 338 comments with a qualitative codebook established using a subset of user posts via inductive and deductive methods. Posts and comments were independently reviewed by two coders with a third coder resolving discrepancies. The top 200 subreddits with the most activity by r/fentanyl members were also inductively analyzed to understand interests of r/fentanyl users. Results: Functional/quality of life impairments due to substance misuse (29%) was the most commonly occurring theme, followed by polysubstance use (27%) and tolerance/dependence/withdrawal (20%). Additional themes included drug identification with photos, substances cut with other drugs, injection drugs, and past overdoses. Media-focused subreddits and other drug focused communities were among the communities most often followed by r/fentanyl users. Conclusion: Themes closely align with DSM-V substance use disorder symptoms for fentanyl and other substances. High involvement in media-focused subreddits and other substance-misuse-related communities suggests digital platforms as acceptable for overdose prevention and recovery support interventions.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Lindsey M. Filiatreau
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Nina Kaiser
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Kevin Davet
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Jordan Taylor
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
| | - Sanjana Garg
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | - Mai El Sherief
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | - Talayeh Aledavood
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30332
| | | | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130
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7
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Rigg KK, Strickland S. Patterns of opioid misuse initiation among African-Americans. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2173050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Khary K. Rigg
- Department of Mental Health Law & Policy, University of South Florida, Tampa, FL, USA
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8
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Gjerde H, Bretteville-Jensen AL, Bache-Andreassen L, Hanoa K, Furuhaugen H, Brochmann GW, Vindenes V. Which illicit drugs are injected in Oslo? A study based on analysis of drug residues in used injection equipment and self-reported information. Scand J Public Health 2023; 51:21-27. [PMID: 34538164 PMCID: PMC9900188 DOI: 10.1177/14034948211043984] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND People who inject drugs (PWID) have a high risk of premature death due to fatal overdoses. Newly emerged fentanyls, much more potent than heroin and other opioids, may increase this risk further. Therefore, precise information on injected drugs is critical to improving prevention strategies. AIMS This study aimed to analyse drug residues in used injection equipment in order to determine drug and drug combinations and compare and complement findings with self-reported information. METHODS Used syringes and needles (n=766) were collected at the supervised drug consumption facilities, the needle exchange service and two low-threshold health services for problem drug users in Oslo, Norway. The material was collected every third month from June 2019 to June 2020 and analysed for 64 substances using highly specific analytical methods (ultra-high performance liquid chromatography tandem mass spectrometry). Additionally, a street-recruited sample of PWID was interviewed from 2017 to 2019 regarding their drug injection habits (n=572). RESULTS Heroin (65.5%) or amphetamines (59.8%), often in combination (30.5%), were commonly detected in drug residues. Other opioids, stimulants or benzodiazepines were rarely detected (6.1%). Fentanyl was detected in only one syringe. Heroin was the most reported drug (77.6% during the past four weeks, 48.3% daily/almost daily), followed by amphetamines (57.5% during the past four weeks, 23.1% daily or almost daily). Injection of methadone, buprenorphine and dissolved tablets was self-reported more frequently than determined in drug residue findings. CONCLUSIONS
Analysis of the injection equipment proved useful as a non-invasive, rapid and accurate means to obtain detailed information on injected drugs in Oslo and supplement traditional PWID survey information.
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Affiliation(s)
- Hallvard Gjerde
- Section of Drug Abuse Research,
Department of Forensic Sciences, Oslo University Hospital, Norway,Hallvard Gjerde, Oslo University Hospital,
Department of Forensic Sciences, Section for Drug Abuse Research, P.O. Box 4950
Nydalen, NO-0424 Oslo, Norway. E-mail:
| | | | - Lihn Bache-Andreassen
- Section of Drug Abuse Research,
Department of Forensic Sciences, Oslo University Hospital, Norway
| | - Kristin Hanoa
- Department of Alcohol, Tobacco and
Drugs, Norwegian Institute of Public Health, Norway
| | - Håvard Furuhaugen
- Section of Drug Abuse Research,
Department of Forensic Sciences, Oslo University Hospital, Norway
| | - Gerd-Wenche Brochmann
- Section of Drug Abuse Research,
Department of Forensic Sciences, Oslo University Hospital, Norway
| | - Vigdis Vindenes
- Section of Drug Abuse Research,
Department of Forensic Sciences, Oslo University Hospital, Norway,Institute of Clinical Medicine, Faculty
of Medicine, University of Oslo, Norway
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Walters SM, Felsher M, Frank D, Jaiswal J, Townsend T, Muncan B, Bennett AS, Friedman SR, Jenkins W, Pho MT, Fletcher S, Ompad DC. I Don't Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1648. [PMID: 36674402 PMCID: PMC9864395 DOI: 10.3390/ijerph20021648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. METHODS Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods. RESULTS Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting and/or changing the route of transmission. Approximately half of persons who inject drugs sampled had heard of fentanyl test strips, however fentanyl test strip use was low. To reverse overdoses, participants reported using cold water baths. Use of naloxone to reverse overdose was low. Barriers to naloxone access and use included fear of arrest and opioid withdrawal. CONCLUSIONS People who inject drugs understood fentanyl to be a potential contaminant in their drug supply and actively engaged in harm reduction techniques to try to prevent overdose. Interventions to increase harm reduction education and information about and access to fentanyl test strips and naloxone would be beneficial.
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Affiliation(s)
- Suzan M. Walters
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
| | - Marisa Felsher
- College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - David Frank
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jessica Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Tarlise Townsend
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Brandon Muncan
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Alex S. Bennett
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Samuel R. Friedman
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Wiley Jenkins
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL 62702, USA
| | - Mai T. Pho
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | | | - Danielle C. Ompad
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY 10003, USA
- Center for Drug Use and HIV/HCV Research, New York, NY 10003, USA
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10
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Tran T, Rigg KK. Substance use among methadone patients in Vietnam: a systematic review. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2022.2162989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Tram Tran
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, USA
| | - Khary K. Rigg
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, USA
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11
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Fernandez P, Azucar D, Zambole K. A Dose of Truth: A Qualitative Assessment of Reactions to Messages about Fentanyl for People Who Use Drugs. Subst Use Misuse 2023; 58:520-527. [PMID: 36762461 DOI: 10.1080/10826084.2023.2177112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Background: Fentanyl-related overdoses are occurring at alarming rates and developing campaigns to increase awareness about fentanyl and harm-reduction strategies is critical. A Dose of Truth is an educational campaign aiming to increase knowledge about the threat of fentanyl and risk of exposure among people who use drugs (PWUD). The current study tests preliminary concepts and messages for the campaign. Methods: Twenty-one one-on-one interviews were conducted with young adults ages 18-35 who use drugs. Participants discussed knowledge of fentanyl and perceived risk of exposure, and provided feedback on four concepts. Thematic analysis of transcripts generated insights about promising approaches and topics. Results: Findings demonstrated that fentanyl awareness is growing among PWUD, but they perceive low risk of exposure because they trust a source. Messaging that challenged that trust, by highlighting that contaminated drug supplies are increasingly widespread, made personal risk salient. Additionally, messaging conveyed through a personal narrative that encouraged carrying naloxone to protect friends was perceived as personally relevant. Conclusions: While opioid- and fentanyl-related campaigns exist, few have used an evidence-based process to guide campaign development. Addressing gaps in knowledge and developing messages that are personally relevant are foundational steps in creating effective campaigns on fentanyl and other substances.
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Affiliation(s)
| | | | - Kim Zambole
- Prevention First, Springfield, Illinois, USA
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12
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McMahan VM, Arenander J, Matheson T, Lambert AM, Brennan S, Green TC, Walley AY, Coffin PO. “There’s No Heroin Around Anymore. It’s All Fentanyl.” Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study. JMIR Form Res 2022; 6:e37483. [PMID: 36069781 PMCID: PMC9494212 DOI: 10.2196/37483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/13/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background Drug overdose mortality continues to increase, now driven by fentanyl. Prevention tools such as naloxone and medications to treat opioid use disorder are not sufficient to control overdose rates; additional strategies are urgently needed. Objective We sought to adapt a behavioral intervention to prevent opioid overdose (repeated-dose behavioral intervention to reduce opioid overdose [REBOOT]) that had been successfully piloted in San Francisco, California, United States, to the setting of Boston, Massachusetts, United States, and the era of fentanyl for a full efficacy trial. Methods We used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework for intervention adaptation. We first identified opioid overdose survivors who were actively using opioids as the population of interest and REBOOT as the intervention to be adapted. We then performed theater testing and elicited feedback with 2 focus groups (n=10) in Boston in 2018. All participants had used opioids that were not prescribed to them in the past year and experienced an opioid overdose during their lifetime. We incorporated focus group findings into our initial draft of the adapted REBOOT intervention. The adapted intervention was reviewed by 3 topical experts, and their feedback was integrated into a subsequent draft. We trained study staff on the intervention and made final refinements based on internal piloting. This paper describes the overall ADAPT-ITT process for intervention adaptation, as well as a qualitative analysis of the focus groups. Working independently, 2 authors (VMM and JA) reviewed the focus group transcripts and coded them for salient and common themes using the constant comparison method, meeting to discuss any discrepancies until consensus was reached. Codes and themes were then mapped onto the REBOOT counseling steps. Results Focus group findings contributed to substantial changes in the counseling intervention to better address fentanyl overdose risk. Participants described the widespread prevalence of fentanyl and said that, although they tried to avoid it, avoidance was becoming impossible. Using alone and lower opioid tolerance were identified as contributors to overdose risk. Slow shots or tester shots were acceptable and considered effective to reduce risk. Naloxone was considered an effective reversal strategy. Although calling emergency services was not ruled out, participants described techniques to prevent the arrival of police on the scene. Expert review and internal piloting improved the intervention manual through increased participant centeredness, clarity, and usability. Conclusions We successfully completed the ADAPT-ITT approach for an overdose prevention intervention, using theater testing with people who use opioids to incorporate the perspectives of people who use drugs into a substance use intervention. In the current crisis, overdose prevention strategies must be adapted to the context of fentanyl, and innovative strategies must be deployed, including behavioral interventions. Trial Registration ClinicalTrials.gov NCT03838510; https://clinicaltrials.gov/ct2/show/NCT03838510
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Affiliation(s)
- Vanessa M McMahan
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Justine Arenander
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Audrey M Lambert
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, School of Medicine, Boston University, Boston, MA, United States
- Boston Medical Center, Boston University, Boston, MA, United States
| | - Sarah Brennan
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Traci C Green
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, United States
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, School of Medicine, Boston University, Boston, MA, United States
- Boston Medical Center, Boston University, Boston, MA, United States
| | - Phillip O Coffin
- San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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13
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Urmanche AA, Beharie N, Harocopos A. Fentanyl preference among people who use opioids in New York City. Drug Alcohol Depend 2022; 237:109519. [PMID: 35714532 PMCID: PMC10089663 DOI: 10.1016/j.drugalcdep.2022.109519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several studies have pointed to a sub-sample of people who use drugs (PWUD) who prefer the use of non-pharmaceutical fentanyl (NPF) and, as such, pose a unique challenge for public health initiatives amidst the continued rise in overdose mortality. However, matters of drug preference and autonomy of choice remain under-studied and often misunderstood. This paper examined the experiences of PWUD reporting a preference for NPF or an NPF-heroin mixture, specifically how they navigate the perceived benefits of NPF and its established risks. METHODS 22 in-depth interviews were conducted in New York City between March 2018 and August 2019 with PWUD who self-reported a preference for NPF or an NPF-heroin mix. Interviews were audio-recorded, and the resulting transcripts analyzed using a thematic approach. RESULTS Participants highlighted various factors that contributed to expressed preference for NPF or an NPF-heroin mix, including a desire to feel good, financial resources, drug availability, decreased consumer autonomy, and physiological demand. Participants reported practicing several risk reduction strategies; however, they highlighted that many, particularly carrying naloxone and always using with someone else, were difficult to implement in the context of illicit drug use. CONCLUSIONS Our results demonstrate participants' decreased consumer agency and greater exposure to systemic factors in the illicit markets, highlighting the need for expansion of various services, including drug checking resources and systems of outreach for PWUD who do not use intravenously. To promote tailored interventions, continued efforts in overdose prevention ought to more thoughtfully consider the context, perceptions, preferences, and behaviors of PWUD.
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Affiliation(s)
- Adelya A Urmanche
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY 11101, USA; Derner School of Psychology, Adelphi University, Hy Weinberg Center, 158 Cambridge Avenue, Garden City, NY 11530, USA.
| | - Nisha Beharie
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY 11101, USA.
| | - Alex Harocopos
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY 11101, USA.
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14
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Shin SS, LaForge K, Stack E, Pope J, Leichtling G, Larsen JE, Leahy JM, Seaman A, Hoover D, Chisholm L, Blazes C, Baker R, Byers M, Branson K, Korthuis PT. "It wasn't here, and now it is. It's everywhere": fentanyl's rising presence in Oregon's drug supply. Harm Reduct J 2022; 19:76. [PMID: 35818072 PMCID: PMC9275036 DOI: 10.1186/s12954-022-00659-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade. Methods We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. Results PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. Conclusion PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00659-9.
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Affiliation(s)
- Sarah S Shin
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA.
| | - Kate LaForge
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | - Erin Stack
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | - Justine Pope
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | | | - Jessica E Larsen
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Judith M Leahy
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Andrew Seaman
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA.,Old Town Clinic/Central City Concern, Portland, OR, USA.,Better Life Partners, Hanover, NH, USA
| | - Daniel Hoover
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Laura Chisholm
- Injury and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Christopher Blazes
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Robin Baker
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | | | - Katie Branson
- Injury and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - P Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA.,School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
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15
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Kaplowitz E, Macmadu A, Green TC, Berk J, Rich JD, Brinkley-Rubinstein L. "It's probably going to save my life;" attitudes towards treatment among people incarcerated in the era of fentanyl. Drug Alcohol Depend 2022; 232:109325. [PMID: 35114617 PMCID: PMC9042078 DOI: 10.1016/j.drugalcdep.2022.109325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In recent years, there has been a dramatic increase in overdose deaths involving illicitly manufactured fentanyl. The risk of death due to fentanyl exposure is far higher for people without adequate tolerance, such as those being released from incarceration. However, little is known about knowledge and perceptions of fentanyl among people who are incarcerated. METHODS We conducted 40 semi-structured qualitative interviews with people who were incarcerated at the Rhode Island Department of Corrections (RIDOC). We explored the impressions of, preferences for and experiences with fentanyl among these people. Analysis employed a general, inductive approach using NVivo 12. RESULTS We found that a majority of the participants were familiar with fentanyl, sought to avoid it and utilized harm reduction techniques when using drugs and taking treatment with medication for opioid use disorder (MOUD) to reduce their risk of overdose. DISCUSSION Our findings suggest that broad access to MOUD, especially for incarcerated people, is increasingly necessary in the era of fentanyl, both to aid people seeking recovery due to the increased overdose risk of drug use and to reduce overdose morbidity for people who use drugs.
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Affiliation(s)
- Eliana Kaplowitz
- The Center for Health + Justice Transformation, The Miriam Hospital, Providence, RI, USA; Center of Biomedical Research Excellence on Opioids and Overdose, The Rhode Island Hospital, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Alexandria Macmadu
- The Center for Health + Justice Transformation, The Miriam Hospital, Providence, RI, USA,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Traci C. Green
- Center of Biomedical Research Excellence on Opioids and Overdose, The Rhode Island Hospital, Providence, RI, USA,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA,The Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA,Brown University School of Medicine, Providence, RI, USA
| | - Justin Berk
- Brown University School of Medicine, Providence, RI, USA,Rhode Island Department of Correction, Providence, RI, USA
| | - Josiah D. Rich
- The Center for Health + Justice Transformation, The Miriam Hospital, Providence, RI, USA,Center of Biomedical Research Excellence on Opioids and Overdose, The Rhode Island Hospital, Providence, RI, USA,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA,Brown University School of Medicine, Providence, RI, USA
| | - Lauren Brinkley-Rubinstein
- The Center for Health + Justice Transformation, The Miriam Hospital, Providence, RI, USA,Department of Social Medicine, University of North Carolina at Chapel Hill, USA
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16
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Trappen SL, McLean KJ. Policing pain: A qualitative study of non-criminal justice approaches to managing opioid overdose during the COVID-19 pandemic. J Prev Interv Community 2021; 49:136-151. [PMID: 33998397 DOI: 10.1080/10852352.2021.1908206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Opioid related drug overdose deaths are a leading cause of death and injury in the United States. While research demonstrates that where people live has a major impact on drug use and abuse, most work looks at social dynamics at the county level or under the rubric of the urban/rural divide. Only recently, scholarship has become attuned to the post-industrialized areas located on the fringes of urban cores. Data presented in here are from field research conducted in McKeesport, Pennsylvania, a small river town located east of Pittsburgh. Once a thriving industrial city, it is now deteriorated and has documented high levels of overdose experience. Preliminary results suggest that McKeesport residents, even before the emergence of SARS-CoV-2 (COVID-19), practice social and physical distancing as a way of life; data indicate how the pandemic potentially exacerbates the risk of accidental opioid overdose among a population defined by both geographic and social isolation.
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Affiliation(s)
- Sandra L Trappen
- Department of Criminal Justice, Penn State University, Greater Allegheny, McKeesport, PA, USA
| | - Katherine J McLean
- Department of Criminal Justice, Penn State University, Greater Allegheny, McKeesport, PA, USA
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17
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Moeller K, Svensson B, Munksgaard R. Fentanyl analogs on the Swedish webforum flashback: Interest and impact of scheduling. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:103013. [PMID: 33181448 DOI: 10.1016/j.drugpo.2020.103013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sweden regulates new psychoactive substances, including fentanyl analogs, individually. This reactive scheduling procedure enabled the existence of a recreational market for unscheduled fentanyl analogs sold from surface webshops. We measure the interest in 24 named fentanyl analogs and the impact of scheduling. METHODS We scraped posts in threads on named fentanyl analogs from the Swedish internet forum Flashback.org, 2012-2019. The sample consists of 24 threads with a total of 8761 posts. We construct five measures of interest based on duration of threads, number of posts, and number of distinct posters, and fit a non-seasonal ARMA model to test if there was a change in mean activity after scheduling. RESULTS Across the five measures, there was most interest in acryl fentanyl, butyr fentanyl, and acetyl fentanyl. The number of daily posts was significantly reduced in nine out of 13 threads after scheduling. CONCLUSION The scheduling of fentanyl analogs impacted interest on Flashback.org. The biggest effect sizes were from the narcotics scheduling of 2-Me-MAF, acryl, and acetyl fentanyl, while furanyl fentanyl saw the biggest reduction after health scheduling. The reductions were bigger for narcotics scheduling compared to health scheduling.
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Affiliation(s)
- Kim Moeller
- Department of Criminology, Malmö University, Sweden.
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18
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Speed KA, Gehring ND, Launier K, O'Brien D, Campbell S, Hyshka E. To what extent do supervised drug consumption services incorporate non-injection routes of administration? A systematic scoping review documenting existing facilities. Harm Reduct J 2020; 17:72. [PMID: 33028363 PMCID: PMC7539556 DOI: 10.1186/s12954-020-00414-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Most of the existing research on supervised consumption services (SCS) is focused on injection drug use. Less is known about the applicability of SCS for people who consume drugs orally, intranasally, or through inhalation. This is problematic because people who use drugs through modes other than injection are also at risk of overdose death and other harm, and experience barriers accessing health and social services. We aimed to describe existing SCS models that accommodate these alternate routes of drug consumption, and synthesize available information on characteristics of program participants. METHODS We conducted a systematic scoping review of 9 peer-reviewed and 13 grey literature databases on SCS that incorporate non-injection routes of consumption. We screened 22,882 titles, and excluded 22,843 (99.8%) articles. We ultimately included 39 (0.2%) full-text articles; 28 (72%) of these articles explicitly identified SCS that permit alternate routes of consumption and 21 (54%) discussed characteristics of participants who consume drugs through non-injection routes. Data on study characteristics, terms and definitions, and site and program participant characteristics were extracted and double-coded. Extracted data were analyzed using descriptive statistics and narrative synthesis. RESULTS Included articles describe 48 SCS that permit non-injection routes of consumption, most of which were located in Germany. The majority of these SCS were legally sanctioned and had models of care that were largely comparable to supervised injection services. Notable differences included physical infrastructure such as ventilated rooms or outdoor areas to accommodate inhalation, and shorter time limits on non-injection drug consumption episodes. Program participants engaging in non-injection forms of consumption were typically men over the age of 30 and structurally vulnerable (e.g., experiencing homelessness or unstable housing). CONCLUSIONS Extant academic and grey literature indicates that site characteristics and demographics of program participants of SCS that permit non-injection routes of consumption largely reflect those of supervised injection services. Further research on the range of existing SCS that incorporate non-injection routes of consumption is needed to ensure high quality service provision, and improved health outcomes for people who consume drugs via oral, intranasal, and inhalation routes.
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Affiliation(s)
- Kelsey A Speed
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Katherine Launier
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Daniel O'Brien
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Sandy Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.
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19
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Weicker NP, Owczarzak J, Urquhart G, Park JN, Rouhani S, Ling R, Morris M, Sherman SG. Agency in the fentanyl era: Exploring the utility of fentanyl test strips in an opaque drug market. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102900. [PMID: 32769054 DOI: 10.1016/j.drugpo.2020.102900] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND In Baltimore, the emergence of fentanyl and its analogues exacerbated an existing heroin crisis and increased uncertainty about drug composition and potency. In an effort to reduce overdoses, harm reduction organizations and health departments across the U.S. began distributing fentanyl test strips, a low barrier, inexpensive drug checking strategy. Studies show that people who use drugs (PWUD) frequently suspect that their drugs contain fentanyl and are interested in using fentanyl test strips to check their drugs; however, some people question their usefulness in regions where fentanyl presence is assumed. Understanding the utility of fentanyl test strips in fentanyl-saturated markets is a priority to best tailor interventions. METHODS In-depth interviews (N = 20) were conducted with individuals who reported recent (past 30 days) opioid use in Baltimore, MD. RESULTS Fentanyl was viewed as pervasive, dangerous, and difficult to avoid in the local drug supply. This dominant narrative characterized PWUD as disempowered by the heightened unpredictability of the drug market. While several strategies are used to navigate the drug market, respondents wanted more information about their drugs. In this context, fentanyl test strips were used in unique and unexpected ways to empower PWUD to be savvier market consumers, including avoiding fentanyl when there could be negative social or legal consequences, negotiating with dealers, and helping others in their social network navigate the opaque drug market. CONCLUSION These findings add nuance and place fentanyl preference and use in the context of the drug market. When fentanyl presence is assumed, people used fentanyl test strips in unexpected ways to gain some control over their drug use. Novel uses for fentanyl test strips strengthen existing strategies used to navigate the drug market and mitigate overdose risk, and highlight their potential to quickly disseminate valuable information about the local drug supply.
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Affiliation(s)
- Noelle P Weicker
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, Room 180, Baltimore, MD 21205, USA.
| | - Jill Owczarzak
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, Baltimore, MD 21205, USA.
| | - Glenna Urquhart
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, Baltimore, MD 21205, USA.
| | - Ju Nyeong Park
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, Baltimore, MD 21205, USA.
| | - Saba Rouhani
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, Baltimore, MD 21205, USA; Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624N. Broadway, Baltimore, MD 21205, USA.
| | - Rui Ling
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, Baltimore, MD 21205, USA.
| | - Miles Morris
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, Baltimore, MD 21205, USA.
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, Baltimore, MD 21205, USA.
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20
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Meier A, Moore SK, Saunders EC, McLeman B, Metcalf SA, Auty S, Walsh O, Marsch LA. Understanding the increase in opioid overdoses in New Hampshire: A rapid epidemiologic assessment. Drug Alcohol Depend 2020; 209:107893. [PMID: 32065941 PMCID: PMC7127940 DOI: 10.1016/j.drugalcdep.2020.107893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/10/2020] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND New Hampshire (NH) has had among the highest rates of fentanyl-related overdose deaths per capita in the United States for several years in a row-more than three times the national average in 2016. This mixed-methods study investigated drug-using practices and perspectives of NH residents who use opioids to inform policy in tackling the overdose crisis. METHODS Seventy-six participants from six NH counties completed demographic surveys and semi-structured interviews focused on drug-using practices and perspectives, including use precursors, fentanyl-seeking behaviors, and experiences with overdose. Rigorous qualitative methods were used to analyze interview data including transcription, coding and content analysis. Descriptive statistics were calculated on quantitative survey data. RESULTS Eighty-four percent of interviewees had knowingly used fentanyl in their lifetime, 70 % reported overdosing at least once, and 42 % had sought a batch of drugs known to have caused an overdose. The majority stated most heroin available in NH was laced with fentanyl and acknowledged that variability across batches increased overdose risk. Participants reported high availability of fentanyl and limited access to prevention, treatment, and harm reduction programs. There was widespread support for expanding education campaigns for youth, increasing treatment availability, and implementing needle exchange programs. CONCLUSIONS A confluence of factors contribute to the NH opioid overdose crisis. Despite consensus that fentanyl is the primary cause of overdoses, individuals continue to use it and affirm limited availability of resources to address the problem. Policies targeting innovative prevention, harm reduction, and treatment efforts are needed to more effectively address the crisis.
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Affiliation(s)
- Andrea Meier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, USA.
| | - Sarah K. Moore
- Center for Technology and Behavioral Health, Geisel School
of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, New Hampshire,
03766, USA
| | - Elizabeth C. Saunders
- Center for Technology and Behavioral Health, Geisel School
of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, New Hampshire,
03766, USA.,The Dartmouth Institute, Lebanon, New Hampshire, 03766,
USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, USA.
| | - Stephen A. Metcalf
- Center for Technology and Behavioral Health, Geisel School
of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, New Hampshire,
03766, USA
| | - Samantha Auty
- Boston University School of Public Health, Boston, MA, USA.
| | - Olivia Walsh
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, USA.
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School
of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, New Hampshire,
03766, USA
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21
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Arillotta D, Schifano F, Napoletano F, Zangani C, Gilgar L, Guirguis A, Corkery JM, Aguglia E, Vento A. Novel Opioids: Systematic Web Crawling Within the e-Psychonauts' Scenario. Front Neurosci 2020; 14:149. [PMID: 32256304 PMCID: PMC7093327 DOI: 10.3389/fnins.2020.00149] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background A wide range of novel psychoactive substances (NPSs) are regularly searched and discussed online by e-psychonauts. Among NPSs, the range of prescription/non-prescription opioids (fentanyl and non-fentanyl analogs) and herbal derivatives currently represents a challenge for governments and clinicians. Methods Using a web crawler (i.e., NPS.Finder®), the present study aimed at assessing psychonaut fora/platforms to better understand the online situation regarding opioids. Results The open-web crawling/navigating software identified some 426 opioids, including 234 fentanyl analogs. Of these, 176 substances (162 were very potent fentanyls, including two ohmefentanyl and seven carfentanyl analogs) were not listed in either international or European NPS databases. Conclusion A web crawling approach helped in identifying a large number, indeed higher than that listed by European/international agencies, of unknown opioids likely to possess a significant misuse potential. Most of these novel/emerging substances are still relatively unknown. This is a reason of concern; each of these analogs potentially presents with different toxicodynamic profiles, and there is a lack of docking, preclinical, and clinical observations. Strengthening multidisciplinary collaboration between clinicians and bioinformatics may prove useful in better assessing public health risks associated with opioids.
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Affiliation(s)
- Davide Arillotta
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Flavia Napoletano
- East London Foundation Trust (ELFT), Homerton University Hospital, London, United Kingdom
| | - Caroline Zangani
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Liam Gilgar
- Gabalfa Clinic, Cardiff and Vale NHS Health Board, Cardiff, United Kingdom
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Swansea University Medical School, Institute of Life Sciences, Swansea University, Singleton Park, Swansea, United Kingdom
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Alessandro Vento
- Addictions' Observatory (ODDPSS), Rome, Italy.,School of Psychology, G. Marconi, Telematic University, Rome, Italy.,Department of Mental Health, Rome, Italy
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22
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Mazhnaya A, O'Rourke A, White RH, Park JN, Kilkenny ME, Sherman SG, Allen ST. Fentanyl Preference among People Who Inject Drugs in West Virginia. Subst Use Misuse 2020; 55:1774-1780. [PMID: 32441202 PMCID: PMC7487277 DOI: 10.1080/10826084.2020.1762653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Overdose fatality rates in rural areas surpass those in urban areas with the state of West Virginia (WV) reporting the highest drug overdose death rate in 2017. There is a gap in understanding fentanyl preference among rural people who inject drugs (PWID). The aim of this study is to investigate factors associated with fentanyl preference among rural PWID in WV. Methods: This analysis uses data from a PWID population estimation study conducted in Cabell County, WV in June-July 2018. Factors associated with fentanyl preference were assessed using multivariable Poisson regression with a robust variance estimate. Results: Among PWID who reported having ever used fentanyl (n = 311), 43.4% reported preferring drugs containing fentanyl. Participants reported high levels of socioeconomic vulnerability, including homelessness (57.9%) and food insecurity (66.9%). Recent increases in drug use and injecting more than one drug in the past 6 months were reported by 27.0% and 84.2% of participants, respectively. In adjusted analyses, fentanyl preference was associated with being younger (PrR:0.98, 95% CI: 0.97-1.00), being female (PrR:1.45, 95% CI:1.14-1.83), being a Cabell county resident (PrR:0.60, 95% CI: 0.45-0.81), increased drug use in the past 6 months (PrR:1.28, 95% CI: 1.01-1.63), and injecting fentanyl in the past 6 months (PrR:1.89, 95% CI: 1.29-2.75). Conclusion: Fentanyl preference is highly prevalent among rural PWID in WV and associated with factors that may exacerbate overdose risks. There is an urgent need for increased access to tailored harm reduction services that address risks associated with fentanyl preference.
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Affiliation(s)
- Alyona Mazhnaya
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allison O'Rourke
- DC Center for AIDS Research, Department of Psychology, George Washington University, Washington, District of Columbia, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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23
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Silverstein SM, Daniulaityte R, Martins SS, Miller SC, Carlson RG. "Everything is not right anymore": Buprenorphine experiences in an era of illicit fentanyl. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:76-83. [PMID: 31563098 PMCID: PMC6914257 DOI: 10.1016/j.drugpo.2019.09.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Conducted in the Dayton Metropolitan area of Southwestern Ohio, this qualitative study explores the self-treatment practices of people who use illicit opioids (PWUIO) amidst the new risk environment produced by illicit, non-pharmaceutical fentanyl (NPF). We explore local perceptions of the presence of NPF in the Dayton area, and how this has both positively and negatively impacted practices of non-prescribed buprenorphine use among PWUIO. METHODS This study analyzes qualitative data from 63 interviews conducted between October 2018 and June 2019. Participants were selected from a larger longitudinal study on non-prescribed buprenorphine use among individuals with opioid use disorder. Qualitative interviews were transcribed in their entirety, and their transcriptions were analyzed using NVivo software, drawing on a mix of thematic and inductive coding. RESULTS Interview respondents ranged from 19 to 70 years old, with a mean age of 38.9 years. 54% of them were male, and 85.7% identified as non-Hispanic White. 98.4% of the sample had used heroin, and 93.7% of the sample reported use of NPF. Participants agreed NPF dominated the illicit opioids market in the area, and was perceived as both dangerous and desirable. The domination of NPF and associated overdose experiences prompted some to seek positive change and initiate self-treatment with non-prescribed buprenorphine. For others, NPF sabotaged established practices of harm reduction, as unanticipated experiences of precipitated withdrawals prompted some participants to give up non-prescribed buprenorphine use as a tactic of self-treatment. DISCUSSION The changing nature of heroin/NPF necessarily gives rise to new beliefs surrounding self-treatment attempts, treatment seeking behaviors, and harm reduction practices. While buprenorphine treatment continues to offer promising results for treating opioid use disorders, it is urgent to reconsider how the unpredictable biochemical mixture of NPFs circulating on the streets today may impact the initiation and success of treatment.
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Affiliation(s)
- Sydney M Silverstein
- 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, United States.
| | - 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, United States.
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, 722 West 168th Street 5th Floor Room 509, New York, NY, United States.
| | - Shannon C Miller
- Dayton VA Medical Center/Middletown CBOC, Mental Health Service, 4337 Union Road, Middletown, OH 45005, United States; Departments of Psychiatry & Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, 3171 Research Blvd, Kettering, OH, United States.
| | - Robert G 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, United States.
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24
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Compton WM, Jones CM. Epidemiology of the U.S. opioid crisis: the importance of the vector. Ann N Y Acad Sci 2019; 1451:130-143. [PMID: 31378974 DOI: 10.1111/nyas.14209] [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: 04/08/2019] [Revised: 07/05/2019] [Accepted: 07/17/2019] [Indexed: 12/26/2022]
Abstract
The roots of the remarkably lethal U.S. opioid crisis are complex and inextricably entangled with healthcare, especially in its treatment of another serious health problem: pain. Failures of the healthcare system-including lack of both training in pain management and caution in using an addictive class of medications-precipitated the rise in opioid misuse and addiction over the past two decades, but a wider range of social and economic forces has helped perpetuate the crisis and altered its character. The classic epidemiologic host-agent-environment triad can be augmented for the purpose of elucidating the current opioid crisis by addition of the "vector" to emphasize the importance of purveyors of opioids (licit and illicit), leading to our proposing an expanded host-agent-vector-environment model. Interventions addressing multiple components are needed, including solutions that account for behaviors of all vectors associated with the crisis. For prescription opioids, the vectors include clinicians and pharmaceutical-related companies involved in marketing, prescribing, distributing, and dispensing opioid medications; for illicit opioids, they include drug manufacturing and distribution networks. Attending to the vectors of opioids, while simultaneously implementing a full range of public health, clinical, law enforcement, and other approaches to ending the opioid crisis, may help to improve public health outcomes.
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Affiliation(s)
- Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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