Abstract
BackgroundThe opioid crisis remains a major public health issue in the US and beyond. Despite rapid rises in fentanyl-related mortality nationally, little is known about the role of fentanyl in the occurrence of non-fatal overdose among people who use drugs. We examined the prevalence of non-fatal overdose and perceived fentanyl exposure among syringe services program (SSP) clients and modeled the correlates of non-fatal overdose.MethodsData were drawn from a cross-sectional survey of 203 SSP clients in Baltimore, MD recruited in 2016. Logistic regression models were used to identify the correlates of experiencing non-fatal overdose in the past 12 months.ResultsThe majority (65%) was male, 52% were black, 41% were white, and 37% were homeless. Almost all (97%) used heroin, 64% injected heroin with cocaine (i.e., speedball), and many used other types of drugs. Half (53%) perceived fentanyl presence in their drugs either half, most or all of the time. Lifetime and past 12 month prevalence of non-fatal overdose were 58 and 31%, respectively. Independent correlates of non-fatal overdose in the past 12 months were perceiving fentanyl in drugs more than half the time (aOR = 2.79; 95% CI = 1.00–4.68), speedball injection (aOR = 2.80, 95% CI = 1.26–6.23), non-prescription buprenorphine use (aOR = 6.37; 95% CI = 2.86–14.17), and homelessness (aOR = 3.07; 95% CI = 1.28–7.39).ConclusionsThese data demonstrate that SSP clients are at high-risk of overdose, some of which is likely attributable to fentanyl exposure. Addressing the rising fentanyl epidemic will require comprehensive and innovative strategies that attend to drug use patterns and structural factors such as homelessness.
Highlights
The opioid crisis remains a major public health issue in the US and beyond
Over the last two decades, the opioid overdose epidemic has been largely driven by non-medical prescription opioid use and heroin use [1]; in recent years, dramatic increases in deaths have been
Unadjusted bivariate logistic regression analysis (Table 4) revealed increased odds of recent non-fatal overdose among People who inject drugs (PWID) who thought that their drugs contained fentanyl at least half of the time (OR = 2.48, 95% CI = 1.18–5.22), were non-Hispanic White (OR = 2.20, 95% CI = 1.19–3.99), homeless (OR = 2.94, 95% CI = 1.45–5.95), injected speedball (OR = 2.03, 95% CI = 1.03–3.97), misused prescription opioids in the past 6 months (OR = 2.34, 95% CI = 1.00–5.49), misused non-prescription buprenorphine (OR = 4.39, 95% CI = 2.27–8.51), used public spaces as main place of injection (OR = 2.07, 95% CI = 1.12–3.82), or accessed inpatient hospital-based drug treatment (OR = 3.58, 95% CI = 1.30–9.91)
Summary
The opioid crisis remains a major public health issue in the US and beyond. Despite rapid rises in fentanyl-related mortality nationally, little is known about the role of fentanyl in the occurrence of non-fatal overdose among people who use drugs. Opioid overdose was the leading cause of injury-related death in the US in 2015, surpassing homicides. This crisis has claimed almost half a million lives since 2000 in the US alone [1]. Other correlates of non-fatal overdose include “polysubstance use” (i.e., the use of multiple types of substances that can act synergistically to increase overdose risk, such as the concomitant use of opioids and alcohol, or opioids and benzodiazepines), homelessness, injecting in public spaces (e.g., streets or abandoned houses), and police encounters [8,9,10,11,12,13,14]. The role of fentanyl in non-fatal overdose is an understudied issue in the published literature
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