Consuming illicit opioids during a drug overdose epidemic: Illicit fentanyls, drug discernment, and the radical transformation of the illicit opioid market

Clarke, Sarah Elizabeth Duhart; Kral, Alex H.; Zibbell, Jon E.

doi:10.1016/j.drugpo.2021.103467

Cited by 42 publications

(21 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clearly, additional research and development is needed in collaboration with existing and prospective service users and providers. Even before current drug checking technologies existed, service providers monitored the supply, witnessed the effects of the local supply, and understood and advocated for the needs of their community [ 5 , 29 , 35 , 124 , 125 ]. Integrating instrument knowledge allows the drug checking community to better consider questions such as: What is possible?…”

Section: Discussionmentioning

confidence: 99%

Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations

2023

View full text Add to dashboard Cite

Drug checking is increasingly being explored outside of festivals and events to be an ongoing service within communities, frequently integrated within responses to illicit drug overdose. The choice of instrumentation is a common question, and the demands on these chemical analytical instruments can be challenging as illicit substances may be more complex and include highly potent ingredients at trace levels. The answer remains nuanced as the instruments themselves are not directly comparable nor are the local demands on the service, meaning implementation factors heavily influence the assessment and effectiveness of instruments. In this perspective, we provide a technical but accessible introduction to the background of a few common drug checking methods aimed at current and potential drug checking service providers. We discuss the following tools that have been used as part of the Vancouver Island Drug Checking Project in Victoria, Canada: immunoassay test strips, attenuated total reflection IR-absorption spectroscopy, Raman spectroscopy from powder samples, surface-enhanced Raman scattering in a solution of colloidal gold nanoparticles, and gas chromatography–mass spectrometry. Using four different drug mixtures received and tested at the service, we illustrate the strengths, limitations, and capabilities of such instruments, and expose the scientific theory to give further insight into their analytical results. Each case study provides a walk-through-style analysis for a practical comparison between data from several different instruments acquired on the same sample. Ideally, a single instrument would be able to achieve all of the objectives of drug checking. However, there is no clear instrument that ticks every box; low cost, portable, rapid, easy-to-use and provides highly sensitive identification and accurate quantification. Multi-instrument approaches to drug checking may be required to effectively respond to increasingly complex and highly potent substances demanding trace level detection and the potential for quantification.

show abstract

Section: Discussionmentioning

confidence: 99%

Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations

2023

View full text Add to dashboard Cite

show abstract

“…15,20−22 Other research describes how PWUD examine substances for physical characteristics of fentanyl contamination. 12,23 In response to the information that they had inadvertently used fentanyl, it was common for participants in our study to recount recent drug use experiences that felt atypical, usually involving a stronger than expected level of intoxication. Their stories concur with studies of perceived fentanyl use, in which participants described their physical responses as a way of deducing that they had used fentanyl.…”

Section: Discussionmentioning

confidence: 99%

“Just another thing for me to stress off of:" Responses to Unintentional Fentanyl Use in a Community-based Study of People who Use Opioids

Lorvick

Hemberg

George

et al. 2023

Preprint

View full text Add to dashboard Cite

The unintentional consumption of fentanyl is a serious health risk for people who use illicit drugs. In an ongoing community-based study regarding polysubstance use among people who use opioids, we found that 17 of 58 (29%) of participants who did not endorse fentanyl use in the past thirty days tested positive for fentanyl during point-of-care urinalysis (UA). This paper describes the reactions and experiences of participants who were informed they had consumed fentanyl unintentionally, as well as how the research team handled the unanticipated occurrence of discordant results. Consistent with other recent studies, we found that people learning of unintentional fentanyl use expressed strong concerns about accidental overdose. It was common for participants to reflect on recent substance use experiences that were atypical and might have involved fentanyl, as well as to examine sources of recent drug purchases. While not all participants were surprised that they had unintentionally consumed fentanyl, all felt that learning their positive results was important due to risk of overdose. Research and medical staff who routinely conduct urinalysis have an opportunity to promote awareness of possible contamination by sharing and discussing UA test results with people who use drugs in non-judgmental manner. In addition to the widely promoted harm reduction strategy of testing drugs with fentanyl test strips, self-administered UA, particularly after an unexpected reaction to using a drug, could provide useful information for people buying and using illicit drugs.

show abstract

“…PWUD in regions with earlier fentanyl saturation are aware of the changing drug supply [ 7 ] and the dangers of fentanyl and have made suggestions for reducing harm and risk of overdose. These suggestions include non-law enforcement emergency response to overdose [ 8 ]; titration of naloxone in a medical setting to ease withdrawal [ 9 ]; respect and empathy within the healthcare system [ 9 , 10 ]; access to syringe service programs and harm reduction tools [ 11 , 12 ]; expansion of treatment centers, detox facilities, and housing shelters [ 10 ]; and peer-delivered services and information [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“It wasn’t here, and now it is. It’s everywhere": fentanyl’s rising presence in Oregon’s drug supply

Shin¹,

LaForge²,

Stack³

et al. 2022

Harm Reduct J

View full text Add to dashboard Cite

Background Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade. Methods We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. Results PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. Conclusion PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD.

show abstract

Consuming illicit opioids during a drug overdose epidemic: Illicit fentanyls, drug discernment, and the radical transformation of the illicit opioid market

Cited by 42 publications

References 54 publications

Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations

Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations

“Just another thing for me to stress off of:" Responses to Unintentional Fentanyl Use in a Community-based Study of People who Use Opioids

“It wasn’t here, and now it is. It’s everywhere": fentanyl’s rising presence in Oregon’s drug supply

Contact Info

Product

Resources

About