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Int J Drug Policy. 2017 Aug;46:136-145. doi: 10.1016/j.drugpo.2017.05.023. Epub 2017 Jun 1.

Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study.

Author information

1
The Warren Alpert School of Medicine of Brown University, 222 Richmond St., Providence, RI 02903, USA; Division of Infectious Diseases, The Miriam Hospital, 164 Summit Ave, Providence, RI 02906, USA. Electronic address: jennifer_carroll@brown.edu.
2
Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Box G-S-121-2, Providence, RI 02912, USA.
3
The Warren Alpert School of Medicine of Brown University, 222 Richmond St., Providence, RI 02903, USA; Division of Infectious Diseases, The Miriam Hospital, 164 Summit Ave, Providence, RI 02906, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Box G-S-121-2, Providence, RI 02912, USA.
4
The Warren Alpert School of Medicine of Brown University, 222 Richmond St., Providence, RI 02903, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Box G-S-121-2, Providence, RI 02912, USA; Department of Emergency Medicine, Boston University School of Medicine, 771 Albany St., Room 1208, Boston, MA 02118, USA.

Abstract

BACKGROUND:

Illicit fentanyl use has become wide spread in the US, causing high rates of overdose deaths among people who use drugs. This study describes patterns and perceptions of fentanyl exposure among opioid users in Rhode Island.

METHODS:

A mixed methods study was conducted via questionnaire with a convenience sample of 149 individuals using illicit opioids or misusing prescription opioids in Rhode Island between January and November 2016. Of these, 121 knew of fentanyl and reported known or suspected exposure to fentanyl in the past year. Semi-structured interviews were conducted with the first 47 participants.

RESULTS:

Study participants were predominantly male (64%) and white (61%). Demographic variables were similar across sample strata. Heroin was the most frequently reported drug of choice (72%). Self-reported exposure to illicit fentanyl in the past year was common (50.4%, n=61). In multivariate models, regular (at least weekly) heroin use was independently associated with known or suspected fentanyl exposure in the past year (adjusted prevalence ratio (APR)=4.07, 95% CI: 1.24-13.3, p=0.020). In interviews, users described fentanyl as unpleasant, potentially deadly, and to be avoided. Participants reporting fentanyl exposure routinely experienced or encountered non-fatal overdose. Heroin users reported limited ability to identify fentanyl in their drugs. Harm reduction strategies used to protect themselves from fentanyl exposure and overdose, included test hits, seeking prescription opioids in lieu of heroin, and seeking treatment with combination buprenorphine/naloxone. Participants were often unsuccessful in accessing structured treatment programs.

CONCLUSION:

Among illicit opioid users in Rhode Island, known or suspected fentanyl exposure is common, yet demand for fentanyl is low. Fentanyl-contaminated drugs are generating user interest in effective risk mitigation strategies, including treatment. Responses to the fentanyl epidemic should be informed by the perceptions and experiences of local users. The rapid scale-up of buprenorphine/naloxone provision may slow the rate of fentanyl-involved overdose deaths.

KEYWORDS:

Drug use; Fentanyl; Heroin; Medication assisted treatment; Medications for addiction treatment; Overdose; Qualitative methods

PMID:
28578864
PMCID:
PMC5560423
DOI:
10.1016/j.drugpo.2017.05.023
[Indexed for MEDLINE]
Free PMC Article

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