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Golparvar A, Nafeh O, Alzamani M, Singh V, Jennings M. The Development of Disinhibited Social Engagement Disorder: A Case Report on the Psychiatric Implications of Prenatal Fentanyl Use. Cureus 2024; 16:e61078. [PMID: 38915968 PMCID: PMC11196189 DOI: 10.7759/cureus.61078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/26/2024] Open
Abstract
Exposure to drugs during pregnancy can result in neonatal abstinence syndrome (NAS), low birth weight, attention-deficit/hyperactivity disorder (ADHD), and behavioral issues, particularly during the school-age years. Recent research has expanded our understanding of the consequences of fentanyl exposure during pregnancy beyond the more commonly recognized effects, including respiratory complications, neurodevelopmental effects, increased risk of substance use disorders, gastrointestinal complications, cardiovascular effects, epigenetic changes, behavioral and emotional regulation disruptions, and long-term cognitive impairments. We present the case of a five-year-old female placed in foster care with a past medical history of asthma and a past psychiatric history of ADHD, oppositional defiant disorder (ODD), and disinhibited social engagement disorder. Her mother has a long history of substance use during pregnancy. From our interaction with the patient presented, we see that prenatal exposure to substances such as fentanyl and the disruption of attachment figures can have profound and lasting effects on a child's life, encompassing behavioral and cognitive aspects.
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Affiliation(s)
- Ali Golparvar
- Child and Adolescent Psychiatry, BronxCare Health System, Bronx, USA
| | - Omar Nafeh
- Psychiatry, American University of the Caribbean, Bronx, USA
| | - Meena Alzamani
- Psychiatry, American University of the Caribbean, Bronx, USA
| | - Victoria Singh
- Psychiatry, American University of the Caribbean, Bronx, USA
| | - Marilena Jennings
- Child and Adolescent Psychiatry, BronxCare Health System, Bronx, USA
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M FM, Doug LM, Peter F, Vivian F G, Wiley J, P Todd K, William M, Mai P, David S, Tom S, Ryan W, William Z, M YA, Lf CH. Correlates of overdose among 2711 people who use drugs and live in 7 rural US sites. Drug Alcohol Depend 2024; 258:111261. [PMID: 38581919 DOI: 10.1016/j.drugalcdep.2024.111261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Overdose rates in rural areas have been increasing globally, with large increases in the United States. Few studies, however, have identified correlates of non-fatal overdose among rural people who use drugs (PWUD). The present analysis describes correlates of nonfatal overdose among a large multistate sample of rural PWUD. METHODS This is a cross-sectional analysis of data gathered via surveys with PWUD recruited through seven Rural Opioid Initiative (ROI) sites. Descriptive analyses were conducted to assess the prevalence of past 30-day overdose. Generalized estimating equations were used to estimate a series of multivariable models quantifying relationships of select factors to past-month overdose; factors were selected using the Risk Environment Framework. RESULTS The multisite sample included 2711 PWUD, 6% of whom reported overdosing in the past 30 days. In the fully adjusted model, houselessness (AOR=2.27, 95%CI[1.48, 3.48]), a positive test result for Hepatitis C infection (AOR=1.73 95%CI[1.18, 2.52]) and heroin/fentanyl use (AOR= 8.58 95%CI [3.01, 24.50]) were associated with an increased risk of reporting past 30-day overdose, while having a high-school education or less was associated with reduced odds of overdose (AOR=0.52, 95% CI[0.37, 0.74]). CONCLUSION As in urban areas, houselessness, Hepatitis C infection, and the use of heroin and fentanyl were significant correlates of overdose. Widespread access to overdose prevention interventions - including fentanyl test strips and naloxone - is critical in this rural context, with particular outreach needed to unhoused populations, people living with Hepatitis C, and people using opioids.
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Affiliation(s)
- Fadanelli Monica M
- Rollins School of Public Health, 1518 Clifton Dr, Atlanta, GA 30329, USA.
| | | | - Friedmann Peter
- UMass Chan Medical School - Baystate, 3601 Main Street, Springfield, MA 01199, USA
| | - Go Vivian F
- Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Jenkins Wiley
- SIU School of Medicine, 801 N Rutledge St., Springfield, IL 62702, USA
| | - Korthuis P Todd
- Oregon Health & Science University, School of Medicine, 3266 SW Research Dr, Portland, OR 97239, USA
| | - Miller William
- Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC 27599, USA
| | - Pho Mai
- The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Seal David
- Tulane School of Public Health & Tropical Medicine, 1440 Canal St, New Orleans, LA 70112, USA
| | - Stopka Tom
- Tufts University School of Medicine, Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Westergaard Ryan
- University of Wisconsin, School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705-2281, USA
| | - Zule William
- Research Triangle Park, 3040 East Cornwallis Road, P.O. Box 12194, NC 27709-2194, USA
| | - Young April M
- University of Kentucky, College of Public Health, 111 Washington Ave., Lexington, KY 40536, USA
| | - Cooper Hannah Lf
- Rollins School of Public Health, 1518 Clifton Dr, Atlanta, GA 30329, USA
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3
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Fredericksen RJ, Baker R, Sibley A, Estadt AT, Colston D, Mixson LS, Walters S, Bresett J, Levander XA, Leichtling G, Davy-Mendez T, Powell M, Stopka TJ, Pho M, Feinberg J, Ezell J, Zule W, Seal D, Cooper HLF, Whitney BM, Delaney JAC, Crane HM, Tsui JI. Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry. Harm Reduct J 2024; 21:74. [PMID: 38561753 PMCID: PMC10985853 DOI: 10.1186/s12954-024-00986-z] [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: 06/09/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. METHODS We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. RESULTS We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. CONCLUSION In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.
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Affiliation(s)
| | - R Baker
- Oregon Health & Science University, Portland, USA
| | - A Sibley
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - A T Estadt
- The Ohio State University, Colombus, USA
| | - D Colston
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - J Bresett
- Southern Illinois University School of Medicine, Springfield, USA
| | - X A Levander
- Oregon Health & Science University, Portland, USA
| | | | - T Davy-Mendez
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M Powell
- University of Washington, Seattle, USA
| | - T J Stopka
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Medford, USA
| | - M Pho
- University of Chicago, Chicago, USA
| | - J Feinberg
- West Virginia University, Morgantown, USA
| | - J Ezell
- Cornell University, Ithaca, USA
| | - W Zule
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - D Seal
- Tulane University, New Orleans, USA
| | | | | | | | - H M Crane
- University of Washington, Seattle, USA
| | - J I Tsui
- University of Washington, Seattle, USA
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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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McKnight C, Weng CA, Reynoso M, Kimball S, Thompson LM, Jarlais DD. Understanding intentionality of fentanyl use and drug overdose risk: Findings from a mixed methods study of people who inject drugs in New York City. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104063. [PMID: 37270373 PMCID: PMC10524892 DOI: 10.1016/j.drugpo.2023.104063] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND As the proportion of drug overdose deaths involving fentanyl continues to increase in the US, monitoring exposure to and possible changes in intention to use fentanyl among people who use drugs (PWUD) is of great public health importance. This mixed methods study examines intentionality of fentanyl use among persons who inject drugs (PWID) in New York City during a period of unprecedently high rates of drug overdose mortality. METHODS Between October 2021 and December 2022, N = 313 PWID were enrolled in a cross-sectional study that included a survey and urine toxicology screening. A subset of N = 162 PWID also participated in an in-depth interview (IDI) examining drug use patterns, including fentanyl use and experiences with drug overdose. RESULTS 83% of PWID were urine-toxicology positive for fentanyl, though only 18% reported recent intentional fentanyl use. Intentionality of fentanyl use was associated with being younger, white, increased drug use frequency, recent overdose (OD), recent stimulant use, among other characteristics. Qualitative findings suggest PWID tolerance to fentanyl may be increasing, which could result in an increased preference for fentanyl. Concern about overdose was common with nearly all PWID using overdose prevention strategies to avoid it. CONCLUSION The findings from this study demonstrate a high prevalence of fentanyl use among PWID in NYC, despite an expressed preference for heroin. Our results suggest that the pervasiveness of fentanyl may be increasing fentanyl use and tolerance, which may contribute to an increased risk for drug overdose. Expanding access to existing evidence-based interventions such as naloxone and medications for opioid use disorder is necessary to reduce overdose mortality. Further, exploring the implementation of additional novel strategies to reduce the risk of drug overdose should be considered, including other forms of opioid maintenance treatment and expansion and government support for overdose prevention centers.
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Affiliation(s)
- Courtney McKnight
- Center for Drug Use and HIV|HCV Research, New York University School of Global Public Health, New York, NY, USA.
| | - Chenziheng Allen Weng
- Center for Drug Use and HIV|HCV Research, New York University School of Global Public Health, New York, NY, USA
| | - Marley Reynoso
- Center for Drug Use and HIV|HCV Research, New York University School of Global Public Health, New York, NY, USA
| | - Sarah Kimball
- Center for Drug Use and HIV|HCV Research, New York University School of Global Public Health, New York, NY, USA
| | - Lily M Thompson
- Center for Drug Use and HIV|HCV Research, New York University School of Global Public Health, New York, NY, USA
| | - Don Des Jarlais
- Center for Drug Use and HIV|HCV Research, New York University School of Global Public Health, New York, NY, USA
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6
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Daniulaityte R, Ruhter L, Juhascik M, Silverstein S. Attitudes and experiences with fentanyl contamination of methamphetamine: exploring self-reports and urine toxicology among persons who use methamphetamine and other drugs. Harm Reduct J 2023; 20:54. [PMID: 37081499 PMCID: PMC10118220 DOI: 10.1186/s12954-023-00782-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND There are growing concerns about illicitly manufactured fentanyl (IMF) contamination of methamphetamine. This study aims to characterize the lay views and experiences with IMF-contaminated methamphetamine (IMF/meth) and identify participants with unknown IMF exposures through urine toxicology analysis. METHODS Between December-2019 and November-2021, structured interviews were conducted with 91 individuals who reported past 30-day use of methamphetamine and resided in Dayton, Ohio, USA. Lab-based urine toxicology analyses were conducted to identify fentanyl/analogs, methamphetamine, and other drugs. Bivariate analyses were conducted to identify characteristics associated with attitudes and experiences with IMF/meth, and unknown IMF exposures. RESULTS The majority (95.6%) of the study participants were non-Hispanic white, and 52.7% were female. Past 30-day use of methamphetamine was reported on a mean of 18.7 (SD 9.1) days, and 62.6% also reported past 30-day use of heroin/IMF. Most (76.9%) had a history of an unintentional drug-related overdose, but 38.5% rated their current risk for an opioid overdose as none. Besides fentanyl (71.9%), toxicology analysis identified nine fentanyl analogs/metabolites (e.g., 42.7% acetyl fentanyl, 19.0% fluorofentanyl, 5.6% carfentanil), and 12.4% tested positive for Xylazine. The majority (71.4%) believed that IMF/meth was common, and 59.3% reported prior exposures to IMF/meth. 11.2% tested positive for IMF but reported no past 30-day heroin/IMF use (unknown exposure to IMF). Views that IMF/meth was common showed association with homelessness (p = 0.04), prior overdose (p = 0.028), and greater perceived risk of opioid overdose (p = 0.019). Self-reported exposure to IMF/meth was associated with homelessness (p = 0.007) and obtaining take-home naloxone (p = 0.025). Individuals with unknown IMF exposure (test positive for IMF, no reported past 30-day heroin/IMF use) were older (49.9 vs. 41.1 years, p < 0.01), and reported more frequent past 30-day use of methamphetamine (24.4 vs. 18.0 days, p < 0.05). They indicated lower perceived risk of opioid overdose (0.1 vs. 1.9, scale from 0 = "none" to 4 = "high," p < 0.001). DISCUSSION This study suggests a need for targeted interventions for people who use methamphetamine and expansion of drug checking and other harm reduction services.
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Affiliation(s)
- Raminta Daniulaityte
- College of Health Solutions, Arizona State University, 425 N 5Th Street, ABC 121, Phoenix, AZ, 85004, USA.
| | - Lance Ruhter
- College of Health Solutions, Arizona State University, 425 N 5Th Street, ABC 121, Phoenix, AZ, 85004, USA
| | - Matthew Juhascik
- Montgomery County Coroner's Office and Crime Laboratory, Dayton, OH, USA
| | - Sydney Silverstein
- Department of Population and Public Health Sciences, Center for Interventions, Treatment, and Addictions Research, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
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7
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Hochstatter KR, Terplan M, Mitchell SG, Schwartz RP, Dusek K, Wireman K, Gryczynski J. Characteristics and correlates of fentanyl preferences among people with opioid use disorder. Drug Alcohol Depend 2022; 240:109630. [PMID: 36152404 PMCID: PMC9616126 DOI: 10.1016/j.drugalcdep.2022.109630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Fentanyl has come to dominate the U.S. illicit opioid supply. We aimed to characterize and examine correlates of preferences for fentanyl vs. other opioids among individuals starting OUD treatment. METHODS We interviewed 250 adults initiating buprenorphine treatment with positive fentanyl toxicology at intake. We characterized opioid preferences and examined bivariate associations between opioid preference (preference for heroin, fentanyl, heroin-fentanyl mix, or other opioid) and sociodemographic characteristics, psychosocial factors, and substance use behaviors. We then used multinomial logistic regression to examine factors independently associated with fentanyl preferences. RESULTS Over half (52.0 %) of participants preferred fentanyl (21.2 % fentanyl alone, 30.8 % heroin-fentanyl mix). In bivariate comparisons, participants who preferred fentanyl were a higher acuity group with respect to risks and problems in general. In the multinomial logistic regression, people who preferred fentanyl, either alone or mixed with heroin, used non-prescribed buprenorphine less in the 30 days preceding treatment entry compared to people who preferred heroin or other opioids (RRRalone= 0.88 [0.78, 0.99]; P = 0.037 and RRRmixed= 0.91 [0.84, 0.99]; P = 0.046). People who preferred fentanyl alone were also younger (RRR= 0.93 [0.90, 0.97]; P < 0.001) and more likely to have severe mental illness (RRR= 2.5 [1.1, 5.6]; P = 0.027) than people who prefer heroin or other opioids. CONCLUSIONS Many people with OUD report preferring fentanyl. People who express preference for fentanyl differ substantively from those with other opioid preferences, and may be at elevated risk for poor health outcomes. Understanding preferences surrounding fentanyl could inform treatment and harm reduction interventions.
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Affiliation(s)
- Karli R Hochstatter
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - Mishka Terplan
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | | | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - Kristi Dusek
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - Kim Wireman
- Powell Recovery Center, 14S. Broadway, Baltimore, MD 21231, USA
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
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8
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Bailey K, Abramovitz D, Patterson TL, Harvey-Vera AY, Vera CF, Rangel MG, Friedman J, Davidson P, Bourgois P, Strathdee SA. Correlates of recent overdose among people who inject drugs in the San Diego/Tijuana border region. Drug Alcohol Depend 2022; 240:109644. [PMID: 36179507 PMCID: PMC9608984 DOI: 10.1016/j.drugalcdep.2022.109644] [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] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 09/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Along the Mexico-US border, illicitly manufactured fentanyls (fentanyl) have been detected in other illicit drugs, including street opioid formulations known as 'china white.' We studied correlates of recent overdose among people who inject drugs (PWID), focusing on the risk of knowlingly or unknowingly using fentanyl in china white. METHODS From October 2020 - September, 2021 we surveyed participants in San Diego, California and Tijuana, Mexico and employed Poisson regression to identify correlates of recent overdose. RESULTS Of 612 PWID, most were male (74.0 %), Latinx (71.9 %), US residents (67.0 %). Mean age was 43 years. In the last six months, 15.8 % experienced overdose, 31.0 % knowingly used fentanyl and 11.1 % used china white, of whom 77.9 % did not think it contained fentanyl. After controlling for sex and race, factors independently associated with risk of overdose included knowingly using fentanyl, using china white and not believing it contained fentanyl, recent drug rehabilitation, being stopped/arrested by police, and homelessness. Further, PWID who believed china white contained fentanyl were less likely to use it. CONCLUSIONS Both intentional fentanyl use and unintentional exposure to fentanyl via china white were associated with overdose risk; however, PWID who believed china white contained fentanyl were less likely to use it. These data suggest that advanced drug checking systems should be implemented to empower PWID to avoid dangerous street formulations or to plan their drug use knowing its contents. Other overdose risk factors such as decreased tolerance following drug treatment, police interactions, and homelessness also require urgent intervention.
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Affiliation(s)
- Katie Bailey
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Daniela Abramovitz
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Thomas L Patterson
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Alicia Y Harvey-Vera
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America; US-Mexico Border Health Commission, P.º del Centenario 10851, Zona Urbana Rio Tijuana, 22320 Tijuana, BC, Mexico
| | - Carlos F Vera
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Maria Gudelia Rangel
- US-Mexico Border Health Commission, P.º del Centenario 10851, Zona Urbana Rio Tijuana, 22320 Tijuana, BC, Mexico; Universidad Xochicalco, Escuela de Medicina, Campus Tijuana, Rampa Yumalinda 4850, Chapultepec Alamar, 22110 Tijuana, BC, Mexico.
| | - Joseph Friedman
- University of California Los Angeles Center for Social Medicine, B7-435, UCLA Semel Institute, Los Angeles, CA 90095-1759, United States of America.
| | - Peter Davidson
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
| | - Philippe Bourgois
- University of California Los Angeles Center for Social Medicine, B7-435, UCLA Semel Institute, Los Angeles, CA 90095-1759, United States of America.
| | - Steffanie A Strathdee
- University of California San Diego School of Medicine, 9500 Gilman Drive, mail Code 0507, La Jolla, CA 92093, United States of America.
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9
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Drug checking use and interest among people who inject drugs in Toronto, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103781. [DOI: 10.1016/j.drugpo.2022.103781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/02/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
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Abstract
This paper is the forty-third consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2020 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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Ferguson M, Parmar A, Papamihali K, Weng A, Lock K, Buxton JA. Investigating opioid preference to inform safe supply services: A cross sectional study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 101:103574. [PMID: 35007878 DOI: 10.1016/j.drugpo.2021.103574] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The drug toxicity crisis continues to be a significant cause of death. Over 24,600 people died from opioid toxicity in Canada over the last 5 years. Safe supply programs are required now more than ever to address the high rate of drug toxicity overdose deaths caused by illicit fentanyl and its analogues. This study aims to identify opioid preferences and associated variables to inform further phases of safe supply program implementation. METHODS The Harm Reduction Client Survey, an annual cross-sectional survey of people who use drugs (PWUD), was administered at harm reduction supply distribution sites in BC in October-December 2019. The survey collects information on substance use patterns, associated harms, stigma, and utilization of harm reduction services. Eligibility criteria for survey participation included aged 19 years or older; self-reported substance use of any illicit substance in the past six months, and ability to provide verbal informed consent. We conducted multivariate logistic regression to investigate associations with opioid preference. We used the dichotomized preference for either heroin or fentanyl as an outcome variable. Explanatory variables of interest included: geographic region, urbanicity, gender, age category, Indigenous identity, housing, employment, witnessing or experiencing an overdose, using drugs alone, using drugs at an observed consumption site, injection as preferred mode of use, injecting any drug, frequency of use, and drugs used in last 3 days. RESULTS Of the 621 survey participants, 405 reported a preferred opioid; of these 57.8% preferred heroin, 32.8% preferred fentanyl and 9.4% preferred prescription opioids. The proportion of participants who preferred heroin over fentanyl significantly increased with age. The adjusted odds of a participant 50 or older preferring heroin was 6.76 (95% CI: 2.78-16.41, p-value: < 0.01) times the odds of an individual 29 or under. The adjusted odds of an Indigenous participant reporting a preference for heroin compared to fentanyl was 1.75 (95% CI: 1.03-2.98, p-value: 0.04) the odds of a non-Indigenous participant reporting the same. Adjusted odds of heroin preference also differed between geographic regions within British Columbia, Canada. CONCLUSION Opioid preference differs by age, geographic area, and Indigenous identity. To create effective safe supply programs, we need to engage PWUD about their drugs of choice.
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Affiliation(s)
- Max Ferguson
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Amrit Parmar
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Kristi Papamihali
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Anita Weng
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kurt Lock
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jane A Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
PURPOSE OF REVIEW This review provides an update on recently published literature on the rise of illicit fentanyls, risks for overdose, combinations with other substances, e.g. stimulants, consequences, and treatment. RECENT FINDINGS Overdose due to illicit synthetic opioids (e.g. fentanyl and fentanyl analogs) continues to rise in the US both preceding and during the COVID-19 pandemic. Fentanyl-related overdose is rising in new geographic areas e.g. the western USA. Stimulant-related overdose is also increasing nationwide driven by methamphetamine and cocaine. Polysubstance use, e.g. the use of a stimulant along with an opioid is driving stimulant-related overdose. Other medical consequences of injection drug use are rising including HIV and hepatitis C infections. Medication approaches to treating opioid use disorder remain the standard of care and there are new promising pharmacological approaches to treating methamphetamine use disorder. SUMMARY A 'fourth wave' of high mortality involving methamphetamine and cocaine use has been gathering force in the USA. Availability and use of illicit fentanyls are still the major drivers of overdose deaths and the current rise in stimulant-related deaths appears entwined with the ongoing opioid epidemic.
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Affiliation(s)
- Daniel Ciccarone
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
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13
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Allen ST, Mazhnaya A, O'Rourke A, White RH, Wedlock P, Grieb SM, Kilkenny ME, Walls M, Sherman SG. Factors Associated with Sterile Syringe Acquisition among People Who Inject Drugs in West Virginia. Subst Use Misuse 2021; 56:1776-1784. [PMID: 34311667 DOI: 10.1080/10826084.2021.1954023] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) are evidence-based interventions that provide essential overdose and infectious disease prevention resources to people who inject drugs (PWID). Little research has examined factors associated with sterile syringe acquisition at SSPs among rural PWID populations. OBJECTIVES We aim to identify factors associated with PWID in a rural county in West Virginia having recently acquired sterile syringes at an SSP. METHODS PWID (n = 420) completed a survey that included measures related to sociodemographics, structural vulnerabilities, and substance use. We used multivariable Poisson regression with robust variance estimation to examine independent associations with sterile syringe acquisition at an SSP. RESULTS Sixty-five percent of our sample reported having recently acquired sterile syringes at an SSP. Factors associated with recent sterile syringes acquisition at an SSP included: being older (aPR [adjusted prevalence ratio]: 1.011, 95% CI: 1.003-1.019), single (aPR: 0.862, 95% CI: 0.755-0.984), experiencing food insecurity (aPR: 1.233, 95% CI: 1.062-1.431), recently injecting fentanyl (aPR: 1.178, 95% CI: 1.010-1.375) and prescription opioid pain relievers (aPR: 0.681, 95% CI: 0.551-0.842), and recent naloxone acquisition (aPR: 1.360; 95% CI: 1.178-1.569). Receptive syringe sharing was inversely associated with acquiring sterile syringes at an SSP (aPR: 0.852; 95% CI: 0.741-0.979). CONCLUSION PWID accessing sterile syringes at an SSP was associated with several sociodemographic, structural, and substance use factors. Ensuring rural SSP operations are tailored to local PWID population-level needs is paramount to the prevention of infectious disease outbreaks and overdose fatalities.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alyona Mazhnaya
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Allison O'Rourke
- DC Center for AIDS Research, Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patrick Wedlock
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Suzanne M Grieb
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Melissa Walls
- Department of International Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan G Sherman
- Department of Health, Behavior, Society; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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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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