Fentanyl-contaminated drugs and non-fatal overdose among people who inject drugs in Baltimore, MD

Abstract

BackgroundThe opioid crisis remains a major public health issue in the US and beyond. Despite rapid rises in fentanyl-related mortality nationally, little is known about the role of fentanyl in the occurrence of non-fatal overdose among people who use drugs. We examined the prevalence of non-fatal overdose and perceived fentanyl exposure among syringe services program (SSP) clients and modeled the correlates of non-fatal overdose.MethodsData were drawn from a cross-sectional survey of 203 SSP clients in Baltimore, MD recruited in 2016. Logistic regression models were used to identify the correlates of experiencing non-fatal overdose in the past 12 months.ResultsThe majority (65%) was male, 52% were black, 41% were white, and 37% were homeless. Almost all (97%) used heroin, 64% injected heroin with cocaine (i.e., speedball), and many used other types of drugs. Half (53%) perceived fentanyl presence in their drugs either half, most or all of the time. Lifetime and past 12 month prevalence of non-fatal overdose were 58 and 31%, respectively. Independent correlates of non-fatal overdose in the past 12 months were perceiving fentanyl in drugs more than half the time (aOR = 2.79; 95% CI = 1.00–4.68), speedball injection (aOR = 2.80, 95% CI = 1.26–6.23), non-prescription buprenorphine use (aOR = 6.37; 95% CI = 2.86–14.17), and homelessness (aOR = 3.07; 95% CI = 1.28–7.39).ConclusionsThese data demonstrate that SSP clients are at high-risk of overdose, some of which is likely attributable to fentanyl exposure. Addressing the rising fentanyl epidemic will require comprehensive and innovative strategies that attend to drug use patterns and structural factors such as homelessness.

Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston

“…As observed in the current study and elsewhere, non-injectors appear to report lower interest in SCS/SIF [4], demonstrating the importance of targeted outreach and being attentive in messaging. Given the high co-occurrence of homelessness and reliance on public drug use settings among PWUD [25,31,32], settings with high levels of both conditions may also consider broader structural interventions such as Housing First programs, which have been shown to reduce alcohol use [33,34]. Fentanyl has substantially altered the overdose landscape in North America and in many settings worldwide.…”

“…We measured substance use and overdose history (lifetime and past 6 months), including by drug type and route of administration and experiencing and witnessing a fatal overdose. Items on fentanyl were adapted from previous studies [24,25] and included suspicion of drugs containing fentanyl within the past 6 months and preference for drugs containing fentanyl. The survey also included items on rushing drug purchases, preparation or use due to policing (past year), settings where drugs were usually used (past 30 days), and using drugs alone.…”

Trends in opioid initiation among people who use opioids in three US cities

“…The survey ascertained sociodemographic data (age, race, gender, employment and housing status), current substance use, including recent (past 6 months) illicit fentanyl use and preference, habits surrounding use (route of administration, drug use setting) and overdose history. Questions were adapted from previous work . Employment was defined as full or part‐time employment, excluding illicit income‐generation which pays ‘under the table’ or ‘off the books’, and involvement in the drug or sex trade.…”

Interpersonal and structural factors associated with receptive syringe‐sharing among a prospective cohort of female sex workers who inject drugs

“…Baseline and follow-up surveys also included drug use items based on our previous work (43,44). The primary outcome (recent RSS; in the past 3 months) was assessed using the first response of the following question: "In the last 3 months, did you use any of the following items that you know have been used by someone else?"…”