Abstract
BackgroundExposure to potent synthetic opioids such as illicitly manufactured fentanyl (IMF) has fueled the escalating overdose crisis in the USA, particularly in the east coast. Drug checking services, which allow people who use drugs (PWUD) to learn about the contents of their drugs, remain limited and even criminalized in many states. Further, there is a persistent belief that PWUD are not willing or able to change their behaviors despite being aware of their potential exposure to fentanyl through drug use.MethodsWe conducted a multi-site cross-sectional study among PWUD to assess what behaviors, if any, were employed in the case of suspected fentanyl exposure, and the correlates of engaging in harm reduction behaviors (HRB). PWUD (N = 334) were recruited in Boston (n = 80), Providence (n = 79), and in Baltimore (n = 175). At the time of the survey, no legal drug checking services were available in these cities.ResultsThe majority of PWUD (84%) expressed concern about fentanyl. Among those who suspected fentanyl exposure prior to using their drugs (n = 196), 39% reported employing HRB including using less of the drug (12%) or abstaining altogether (10%), using more slowly (5%), and doing a tester shot (5%). In adjusted logistic regression models, the odds (aOR) of practicing HRB after suspecting fentanyl exposure were increased among PWUD who were non-White (aOR 2.1; p = 0.004) and older (aOR 1.52 per decade of age; p < 0.001). Daily injection (aOR 0.50; p < 0.001), using drugs in public (aOR 0.58; p = 0.001), using drugs alone (aOR 0.68; p < 0.001), and experiencing multiple recent overdoses (aOR 0.55; p < 0.001) were associated with decreased odds of practicing HRB.ConclusionsThese data illustrate that PWUD employ a number of practices to reduce overdose risk in a context of unknown drug purity and content. Results may also guide efforts to identify early adopters of drug checking services and engage them in peer-outreach to target the most socially and structurally vulnerable PWUD, who are not reporting behavior change, with harm reduction messaging.
Highlights
Drug overdoses have been increasing at unprecedented rates in recent years and are a leading cause of death and driver of reduced life expectancy in the USA [1]
This study aims to examine whether and how, in the absence of such services, people who use drugs (PWUD) change their drug use behaviors after suspected fentanyl exposure in three northeastern US cities—Baltimore, Maryland, Providence, Rhode Island, and Boston, Massachusetts—that have been profoundly impacted by the emergence of illicitly manufactured fentanyl (IMF)
This study demonstrates that in three hotspots of the fentanyl epidemic, there is a will and a way to practice harm reduction when faced with fentanyl exposure and risk of death
Summary
Drug overdoses have been increasing at unprecedented rates in recent years and are a leading cause of death and driver of reduced life expectancy in the USA [1]. IMF was estimated to account for 64% of all overdose deaths in Rhode Island and 90% of all fatal opioid overdoses in Massachusetts [7,8,9] This crisis shows little sign of abating; the Centers for Disease Prevention and Control has reported significant increases in fentanyl-related overdose deaths in other regions of the country and in 2018 issued a health alert highlighting the growing list of illicit drugs in which these analogs are detected, including heroin, counterfeit pills, methylenedioxymethamphetamine (MDMA), cocaine, benzodiazepines, ketamine, and methamphetamine [2]. Exposure to potent synthetic opioids such as illicitly manufactured fentanyl (IMF) has fueled the escalating overdose crisis in the USA, in the east coast. There is a persistent belief that PWUD are not willing or able to change their behaviors despite being aware of their potential exposure to fentanyl through drug use
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