Fentanyl overdose concerns among people who inject drugs: The role of sex, racial minority status, and overdose prevention efforts.

Abstract

Background: People who inject drugs (PWID) have an elevated risk of fentanyl-related overdoses. This study explores fentanyl overdose concerns among PWID and the role of sex, racial minority status, and overdose prevention efforts in these concerns. Method: Data were from 498 PWID from Baltimore City, MD, recruited using street-based outreach between 2016 and 2019. Multinomial logistic regressions assessed correlates of participants’ level of concern for themselves and their peers overdosing from fentanyl. Results: A third of participants were female, half were Black, over two-thirds perceived fentanyl to be in all/most of heroin, 40% expressed low fentanyl overdose concern, and a third overdosed in the past 6 months. After controlling for sociodemographic characteristics, female sex was associated with being very concerned about fentanyl overdoses for oneself (adjusted relative risk [aRR]: 2.13; 95% CI: 1.22, 3.72) and peers (aRR: 1.98; 95% CI: 1.14, 3.45). Compared to Black participants, White participants were less likely to be very concerned about fentanyl overdoses for themselves (aRR: 0.35; 95% CI: 0.19, 0.65). Participants who often/always carried naloxone (aRR: 2.91; 95% CI: 1.42, 5.95) perceived fentanyl in most heroin (aRR: 2.78; 95% CI: 1.29, 5.97) or were on medications for opioid use disorder (MOUD) (quite a bit concerned aRR: 2.18; 95% CI: 1.28, 3.69; very concerned: aRR: 1.96; 95% CI: 1.19, 3.22) were more likely than their counterparts to report being concerned for their peers, but not for themselves. Conclusion: Female sex and racial minority status were associated with greater concern regarding fentanyl overdoses for oneself. Increasing overdose deaths in these populations suggests disparate access to harm-reduction initiatives rather than interest or concern. Furthermore, findings on naloxone, MOUD, and concerns for peers support social network-based interventions among PWID.

The impact of family systems and social networks on substance use initiation and recovery among women with substance use disorders.

“…Drug overdose deaths, particularly opioid-attributed deaths, continue to increase among women, necessitating an understanding of salient drivers in their substance use trajectories (Jones, Schneider, Mahlobo, et al, 2023). One such driver is interpersonal relationships, including family, partner, and peer relationships, which substantially impact substance use initiation, treatment utilization, and overdose survival (Bowleg & Landers, 2023; Jones, Duncan, et al, 2023; Van Ryzin et al, 2012).…”

“…While families influence substance use initiation and recovery, peer relationships become more influential as individuals age (Ajayi & Somefun, 2020; Keyzers et al, 2020; Schuler et al, 2019; Tucker et al, 2020). Beyond substance use initiation, social networks have also been shown to influence help-seeking behaviors and harm reduction (e.g., naloxone carrying; Ghosh et al, 2017; Jones, Schneider, Falade-Nwulia, et al, 2023; Jones, Schneider, Mahlobo, et al, 2023; Latkin & Knowlton, 2015). Yet, the influence of social networks on these outcomes differs by sex/gender (Falade-Nwulia et al, 2022; Jones, Schneider, Falade-Nwulia, et al, 2023; Knowlton et al, 2011).…”