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Int J Drug Policy. 2019 Jun;68:46-53. doi: 10.1016/j.drugpo.2019.03.003. Epub 2019 Apr 13.

Acceptability of implementing community-based drug checking services for people who use drugs in three United States cities: Baltimore, Boston and Providence.

Author information

1
Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: ssherman@jhu.edu.
2
Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
3
Miriam Hospital and Alpert Medical School of Brown University, Providence, RI, United States.
4
Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States.
5
Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, United States; Departments of Medicine and Epidemiology, Alpert Medical School of Brown University, Providence, RI, United States.

Abstract

BACKGROUND:

North America is experiencing a rising trend of opioid overdose exacerbated primarily in recent years through adulteration of the heroin supply with fentanyl and its analogues. The east coast of the United States has been particularly hard hit by the epidemic. In three east coast states of Maryland, Massachusetts and Rhode Island, fentanyl has been detected in over half of all overdoses with available toxicology screens. To determine the acceptability of drug checking involving fentanyl test strips (FTS) or other technologies among those at high risk for overdose, we assessed correlates of intention to utilize such services and logistical preferences among people who use drugs (PWUD).

METHODS:

Through FORECAST (the Fentanyl Overdose REduction Checking Analysis STudy), street-based PWUD (N = 334) were recruited in Baltimore, Maryland, Boston, Massachusetts, and Providence, Rhode Island. Questionnaires 7were administered from June to October 2017 and ascertained drug use, overdose history, fentanyl knowledge, and drug checking intent and logistical preferences. Pearson's χ2 and logistic regression determined factors associated with drug checking intent.

RESULTS:

Overall, 84% were concerned about fentanyl, 63% had ever overdosed, and 42% had ever witnessed a fatal overdose. Ninety percent felt drug checking would help them prevent an overdose, the majority of those interested would utilize drug checking at least daily (54%). Factors independently associated with intent to use drug checking included: older age (aOR: 1.5, 95% CI: 1.3-1.8); homelessness (aOR: 0.6, 95% CI: 0.5-0.7); being non-white (aOR: 2.0, 95% CI: 1.0-4.0); witnessing ≥1 fatal overdose (aOR: 1.6, 95% CI:1.1-2.3); and suspected recent fentanyl exposure (aOR: 1.8, 95% CI: 1.1-3.1).

CONCLUSIONS:

The majority of PWUD endorsed drug checking for overdose prevention, with intent amplified by having witnessed a fatal overdose and recent fentanyl exposure. Drug checking should be part of a comprehensive approach to address the risks associated with the proliferation of fentanyl.

KEYWORDS:

Drug checking; Fentanyl; Harm reduction; Opioid overdose; People who use drugs; Prevention

PMID:
30991301
DOI:
10.1016/j.drugpo.2019.03.003
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