Consumer discernment of fentanyl in illicit opioids confirmed by fentanyl test strips: Lessons from a syringe services program in North Carolina

Zibbell, Jon E.; Peiper, Nicholas; Clarke, Sarah Elizabeth Duhart; Salazar, Zach; Vincent, Louise; Kral, Alex H.; Feinberg, Judith

doi:10.1016/j.drugpo.2021.103128

Cited by 21 publications

(18 citation statements)

References 33 publications

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“…There are also a remarkably low number of addiction specialists in the United States, especially from underrepresented minority backgrounds ( Jordan and Jegede, 2020 ). Improving access to harm reduction, including overdose prevention sites and drug checking to detect the presence of fentanyl, represent important strategies that have been incompletely enacted in California ( Johnson and Beletsky, n.d. ; Zibbell et al, 2021 ). However, these approaches are unlikely to be fully sufficient to reverse rising disparities in overdose.…”

Section: Discussionmentioning

confidence: 99%

Growing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in California

Friedman

Hansen

Bluthenthal

et al. 2021

Preventive Medicine

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As overdose mortality is spiking during the COVID-19 pandemic, few race/ethnicity-stratified trends are available. This is of particular concern as overdose mortality was increasing most rapidly in Black and Latinx communities prior to the pandemic. We used quarterly, age-standardized overdose mortality rates from California to assess trends by race/ethnicity and drug involved over time. Rates from 2020 Q2-Q4 were compared to expected trends based on ARIMA forecasting models fit using data from 2006 to 2020 Q1. In 2020 Q2-Q4 overdose death rates rose by 49.8% from 2019, exceeding an expected increase of 11.5% (95%CI: 0.5%–22.5%). Rates significantly exceeded forecasted trends for all racial/ethnic groups. Black/African American individuals saw an increase of 52.4% from 2019, compared to 42.6% among their White counterparts. The absolute Black-White overdose mortality gap rose from 0.7 higher per 100,000 for Black individuals in 2018 to 4.8 in 2019, and further increased to 9.9 during the pandemic. Black overdose mortality in California was therefore 34.3% higher than that of White individuals in 2020 Q2-Q4. This reflects growing methamphetamine-, cocaine-, and fentanyl-involved deaths among Black communities. Growing racial disparities in overdose must be understood in the context of the unequal social and economic fallout from the COVID-19 pandemic, during which time Black communities have been subjected to the dual burden of disproportionate COVID-19 deaths and rising overdose mortality. Increased investments are required to ameliorate racial/ethnic disparities in substance use treatment, harm reduction, and the structural drivers of overdose, as part of the COVID-19 response and post-pandemic recovery efforts.

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Section: Discussionmentioning

confidence: 99%

Growing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in California

Friedman

Hansen

Bluthenthal

et al. 2021

Preventive Medicine

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“…The recent increase in novel synthetic drug types bodes ill for public health and safety because new psychoactive substances (e.g., fentanyl analogs) are frequently unknown by law enforcement and undetected by conventional drug screens, with associated health risks unfamiliar to public health. Evidently, though, people who consume these substances know what they are, or what they are intended to imitate, including what they look like, the places where they are sold, how much they cost, who is using them, methods and techniques for using (e.g., routes of administration), and the social network dynamics that facilitate contacts between consumers (i.e., dyadic pairings) [4].…”

Section: Community Contextualizationmentioning

confidence: 99%

Research led by people who use drugs: centering the expertise of lived experience

Salazar¹,

Vincent²,

Figgatt

et al. 2021

Subst Abuse Treat Prev Policy

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Background Research collaborations between people who use drugs (PWUD) and researchers are largely underutilized, despite the long history of successful, community-led harm reduction interventions and growing health disparities experienced by PWUD. PWUD play a critical role in identifying emerging issues in the drug market, as well as associated health behaviors and outcomes. As such, PWUD are well positioned to meaningfully participate in all aspects of the research process, including population of research questions, conceptualization of study design, and contextualization of findings. Main body We argue PWUD embody unparalleled and current insight to drug use behaviors, including understanding of novel synthetic drug bodies and the dynamics at play in the drug market; they also hold intimate and trusting relationships with other PWUD. This perfectly situates PWUD to collaborate with researchers in investigation of drug use behaviors and development of harm reduction interventions. While PWUD have a history of mistrust with the medical community, community-led harm reduction organizations have earned their trust and are uniquely poised to facilitate research projects. We offer the North Carolina Survivors Union as one such example, having successfully conducted a number of projects with reputable research institutions. We also detail the fallacy of meaningful engagement posed by traditional mechanisms of capturing community voice. As a counter, we detail the framework developed and implemented by the union in hopes it may serve as guidance for other community-led organizations. We also situate research as a mechanism to diversify the job opportunities available to PWUD and offer a real-time example of the integration of these principles into public policy and direct service provision. Conclusion In order to effectively mitigate the risks posed by the fluid and volatile drug market, research collaborations must empower PWUD to play meaningful roles in the entirety of the research process. Historically, the most effective harm reduction interventions have been born of the innovation and heart possessed by PWUD; during the current overdose crisis, there is no reason to believe they will not continue to be.

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“…We define community drug checking as a model of drug checking that is implemented within communities to provide an ongoing service to the whole population which may be unique from event or festival site models. Fentanyl test strips are often integrated within harm reduction services at supervised consumption sites and overdose prevention services and are used off-label to provide a simple positive/negative result of the presence of fentanyl in a sample (Bergh et al , 2021; Park et al , 2021; Peiper et al , 2019; Weicker et al , 2020; Zibbell et al , 2021). At the same time, more sophisticated methods, typically optical-based technologies such as spectrometers, are being pursued for their potential to detect and report on the full composition of a sample including the active (psychoactive) ingredients and cuts and, whenever possible, to determine and report on the concentration of ingredients (Borden et al , 2021; Green et al , 2020; Maghsoudi et al , 2020; Scarfone et al , 2022).…”

Section: Introductionmentioning

confidence: 99%

A distributed model to expand the reach of drug checking

Wallace

Gozdzialski

Qbaich

et al. 2022

DHS

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Purpose While there is increasing interest in implementing drug checking within overdose prevention, we must also consider how to scale-up these responses so that they have significant reach and impact for people navigating the unpredictable and increasingly complex drug supplies linked to overdose. The purpose of this paper is to present a distributed model of community drug checking that addresses multiple barriers to increasing the reach of drug checking as a response to the illicit drug overdose crisis. Design/methodology/approach A detailed description of the key components of a distributed model of community drug checking is provided. This includes an integrated software platform that links a multi-instrument, multi-site service design with online service options, a foundational database that provides storage and reporting functions and a community of practice to facilitate engagement and capacity building. Findings The distributed model diminishes the need for technicians at multiple sites while still providing point-of-care results with local harm reduction engagement and access to confirmatory testing online and in localized reporting. It also reduces the need for training in the technical components of drug checking (e.g. interpreting spectra) for harm reduction workers. Moreover, its real-time reporting capability keeps communities informed about the crisis. Sites are additionally supported by a community of practice. Originality/value This paper presents innovations in drug checking technologies and service design that attempt to overcome current financial and technical barriers towards scaling-up services to a more equitable and impactful level and effectively linking multiple urban and rural communities to report concentration levels for substances most linked to overdose.

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Consumer discernment of fentanyl in illicit opioids confirmed by fentanyl test strips: Lessons from a syringe services program in North Carolina

Cited by 21 publications

References 33 publications

Growing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in California

Growing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in California

Research led by people who use drugs: centering the expertise of lived experience

A distributed model to expand the reach of drug checking

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