Age‐based preferences for risk communication in the fentanyl era: ‘A lot of people keep seeing other people die and that's not enough for them’

Abstract

Aims To explore how people who use fentanyl and health‐care providers engaged in and responded to overdose risk communication interactions, and how these engagements and responses might vary by age. Design A single‐site qualitative in‐depth interview study. Setting Boston, MA, United States. Participants The sample included 21 people (10 women, 11 men) who were either 18–25 or 35+, English‐speaking, and reported illicit fentanyl use in the last year and 10 health‐care providers who worked directly with people who use fentanyl (PWUF) in clinical and community settings. Measurements Open‐ended, flexible interview questions guided by a risk communication framework were used in all interviews. Codes used for thematic analysis included deductive codes related to the risk communication framework and inductive, emergent codes from interview content. Findings We identified potential age‐based differences in perceptions of fentanyl overdose, including that younger participants appeared to display more perceptions of an immunity to fentanyl's lethality, while older people seemed to express a stronger aversion to fentanyl due to its heightened risk of fatal overdose, shorter effects and potential for long‐term health consequences. Providers perceived greater challenges relaying risk information to young PWUF and believed them to be less open to risk communication. Compassionate harm reduction communication was preferred by all participants and perceived to be delivered most effectively by community health workers and peers. PWUF and providers identified structural barriers that limited compassionate harm reduction, including misalignment of available treatment with preferred options and clinical structures that impeded the delivery of risk communication messages. Conclusions Among people who engage in illicit fentanyl use, fentanyl‐related risk communication experiences and preferences may vary by age, but some foundational elements including compassionate, trust‐building approaches seem to be preferred across the age spectrum. Structural barriers in the clinical setting such as provider‐prescribing power and infrequent encounters may impede the providers’ ability to provide compassionate harm reduction communication.

“We need to build a better bridge”: findings from a multi-site qualitative analysis of opportunities for improving opioid treatment services for youth

“…Of note, a number of youth in the study also expressed their desire to take on such peer support roles to help others and for the benefits it would bring to their own opioid use treatment goals (e.g., reducing opioid use). The benefit of peer support in harm reduction, community-based substance use treatment, and hospital settings is increasingly supported by empirical evidence [ 55 , 72 , 73 ]. In addition to the relational benefits (e.g., reduced stigma, reduced power imbalances) [ 55 , 74 ], research suggests that peer support may increase the delivery of information about harm reduction and treatment [ 75 ] and connection to services [ 76 ].…”

Co-Designing High-Risk Drug Alerts for Health and Community Service Practitioners

“…indicators at the micro-, meso-, and macro-levels (53,54) which is often out-of-scope for under-resourced health and harm reduction services. A small body of research has qualitatively evaluated community drug alerts targeting people at risk of experiencing opioid overdose in North America (28,33,34,(55)(56)(57). In summary, alerts must be carefully formulated to provide clear and simple, evidence-based, action-oriented, prompt communications tailored speci cally to target audience needs (55).…”

“…A small body of research has qualitatively evaluated community drug alerts targeting people at risk of experiencing opioid overdose in North America (28,33,34,(55)(56)(57). In summary, alerts must be carefully formulated to provide clear and simple, evidence-based, action-oriented, prompt communications tailored speci cally to target audience needs (55). Information or advice that is perceived to be dated, inaccurate, unrelatable, irrelevant, or impractical can undermine trust and engagement with alert systems (33,56,57).…”

“…Information or advice that is perceived to be dated, inaccurate, unrelatable, irrelevant, or impractical can undermine trust and engagement with alert systems (33,56,57). It is therefore recommended that alert systems carefully prioritize the values, interests, needs, and concerns of target audiences to maximize reach, engagement, and information-sharing (33,34,42,55).…”

“…Word-of-mouth is a powerful tool for disseminating drug-related risk communications (33,55). Health and community services may be ideal locations for opportunistic risk prevention conversations to take place between practitioners and clients/patients, but people who use drugs may not consider healthcare providers reliable sources of drug market information (33,55). A key challenge for workers in these settings is access to timely and reliable information, speci cally regarding novel and emerging trends (58-62).…”