Exploring synthetic heroin: Accounts of acetyl fentanyl use from a sample of dually diagnosed drug offenders

Abstract

Introduction and Aims. Acetyl fentanyl, a fentanyl analogue emerging onto the recreational drug scene, has been responsible for numerous recent fatal overdoses in the USA, Europe and Russia. Studies reporting acetyl fentanyl use are presently limited to case studies and mortality reports. This study explores the nature of acetyl fentanyl use through the collection of first-hand qualitative data from users to inform public health and drug control policy responses. Design and Methods. A series of focus group interviews within a correctional setting-Delaware County (Ohio) Jail, USA. Participants were 102 individuals in one of two US Bureau of Justice Assistance Second Chance Act substance use treatment initiatives participating in at least one focus group session. Five of these individuals reported acetyl fentanyl use. Semi-structured qualitative focus group sessions queried subjects' drugs of choice and nature of drug use. Responses were explored through follow-up organic discourse. Results. Acetyl fentanyl users were generally unaware that they had administered the substance until after use (initially believing that they were administering heroin). They described the effects of acetyl fentanyl as stronger and qualitatively different from heroin. These individuals showed no interest in using acetyl fentanyl again describing it as unpleasant and more risky, both because of potency and the threat of a 'bad batch'. Discussion and Conclusions. Acetyl fentanyl is reaching heroin users, some of which administer it unknowingly. Regulation of acetyl fentanyl is recommended in all countries as is increasing public awareness that the substance is distinct from and being sold as heroin. [Miller JM, Stogner JM, Miller BL, Blough S. Exploring synthetic heroin: Accounts of acetyl fentanyl use from a sample of dually diagnosed drug offenders. Drug Alcohol Rev 2017;00:000-000]

Expected and actual fentanyl exposure among persons seeking opioid withdrawal management

“…We do not know if these are experimental one-time users or recurrent fentanyl users, nor do we know the reasons why respondents sought fentanyl. However, existing studies and anecdotal reports indicate that fentanyl enables a different drug experience than heroin (Miller, Stogner, Miller, & Blough, 2017). In their qualitative study of persons using heroin in Massachusetts and New Hampshire, Ciccarone and colleagues (2017) found that fentanyl’s intensity and potent ability to surpass heroin tolerance or OAT medicine was appealing to some people.…”

Ten Years of Fentanyl-like Drugs: a Technical-analytical Review

“…Scientific literature reported a mixture of p-fluorofentanyl, alphamethylfentanyl, 3-methylfentanyl, acetyl-fentanyl which may include heroin constituents. [11][12][13][14] The danger related to fentanyl derivatives is due to: 1) the variability of compounds that may exist in a given sample 2) the inconsistency of dosages 3) their potency 4) easy access by consumers through the deep web or black market 14,15 and 5) fatal respiratory depression. In recent years, the great spread of fentanyl-like compounds has created massive problems from social, health, normative and analytical points of view.…”

Characterizing fentanyl-related overdoses and implications for overdose response: Findings from a rapid ethnographic study in Vancouver, Canada

“…However, increasing variability in the evolving supply means that some individuals may be unable to discern fentanyl-adulteration (Amlani et al, 2015; Kenney et al, 2018). Research suggests that the fentanyl-adulteration does result in different intoxication effects in comparison heroin, including: intensity of onset, duration of action, increased overdose risk, and other embodied effects (Carroll et al, 2017; Ciccarone, 2017; Ciccarone et al, 2017; Macmadu et al, 2017; Mars et al, 2018; Miller et al, 2017; Somerville, 2017). As a result, fentanyl-adulteration has implications for overdose response in terms of rapid progression, and atypical physical symptoms (Somerville, 2017).…”