<i>Notes from the Field:</i> Unintentional Fentanyl Overdoses Among Persons Who Thought They Were Snorting Cocaine — Fresno, California, January 7, 2019

Armenian, Patil; Whitman, Jeffrey D.; Badea, Adina; Johnson, Whitney; Drake, Chelsea; Dhillon, Simranjit Singh; Rivera, Michelle; Brandehoff, Nicklaus; Lynch, Kara L.

doi:10.15585/mmwr.mm6831a2

Cited by 23 publications

(13 citation statements)

References 5 publications

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“…In 2018, fentanyl was responsible for 67% of opioid-related deaths nationally, but 93% of opioid-related deaths in Massachusetts [2,3]. Fentanyl as the major driver of opioid overdose deaths is likely related to changes in supply, policies that limit opioid prescribing, and contamination of the stimulant and sedative drug supply [4][5][6][7][8]. Since the introduction of fentanyl, people who use drugs are at significantly higher risk of overdose and may have minimal agency to avoid fentanyl use [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Age‐based preferences for risk communication in the fentanyl era: ‘A lot of people keep seeing other people die and that's not enough for them’

et al. 2020

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Aims To explore how people who use fentanyl and health‐care providers engaged in and responded to overdose risk communication interactions, and how these engagements and responses might vary by age. Design A single‐site qualitative in‐depth interview study. Setting Boston, MA, United States. Participants The sample included 21 people (10 women, 11 men) who were either 18–25 or 35+, English‐speaking, and reported illicit fentanyl use in the last year and 10 health‐care providers who worked directly with people who use fentanyl (PWUF) in clinical and community settings. Measurements Open‐ended, flexible interview questions guided by a risk communication framework were used in all interviews. Codes used for thematic analysis included deductive codes related to the risk communication framework and inductive, emergent codes from interview content. Findings We identified potential age‐based differences in perceptions of fentanyl overdose, including that younger participants appeared to display more perceptions of an immunity to fentanyl's lethality, while older people seemed to express a stronger aversion to fentanyl due to its heightened risk of fatal overdose, shorter effects and potential for long‐term health consequences. Providers perceived greater challenges relaying risk information to young PWUF and believed them to be less open to risk communication. Compassionate harm reduction communication was preferred by all participants and perceived to be delivered most effectively by community health workers and peers. PWUF and providers identified structural barriers that limited compassionate harm reduction, including misalignment of available treatment with preferred options and clinical structures that impeded the delivery of risk communication messages. Conclusions Among people who engage in illicit fentanyl use, fentanyl‐related risk communication experiences and preferences may vary by age, but some foundational elements including compassionate, trust‐building approaches seem to be preferred across the age spectrum. Structural barriers in the clinical setting such as provider‐prescribing power and infrequent encounters may impede the providers’ ability to provide compassionate harm reduction communication.

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Section: Introductionmentioning

confidence: 99%

Age‐based preferences for risk communication in the fentanyl era: ‘A lot of people keep seeing other people die and that's not enough for them’

et al. 2020

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“…Although much attention has focused on the dangers associated with fentanyl and other potent synthetic opioids, there is an underlying concern about the “black box” nature of the global illicit drug supply, which remains unregulated and unpredictable, posing serious risks to PWUD. There have been multiple reports of unintentional fentanyl exposures that have led to overdoses among individuals in California, Pennsylvania, and Connecticut who thought they were using cocaine 33 . Community-based studies conducted in urban settings suggest that PWUD rely on subjective assessments (eg, color, taste) and word-of-mouth to seek or avoid fentanyl, and can be unsure whether their drugs contain fentanyl 34–36 .…”

Section: Discussionmentioning

confidence: 99%

“…There have been multiple reports of unintentional fentanyl exposures that have led to overdoses among individuals in California, Pennsylvania, and Connecticut who thought they were using cocaine. 33 Community-based studies conducted in urban settings suggest that PWUD rely on subjective assessments (eg, color, taste) and word-of-mouth to seek or avoid fentanyl, and can be unsure whether their drugs contain fentanyl. [34][35][36] Drug checking programs, including take-home fentanyl test strips and on-site drug checking (eg, spectrometry), provide concrete information about the drug supply and encourage the adoption of risk reduction behaviors.…”

Section: Discussionmentioning

confidence: 99%

Polysubstance Overdose Deaths in the Fentanyl Era: A Latent Class Analysis

Park

Schneider

Fowler

et al. 2021

Journal of Addiction Medicine

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Objectives: To elucidate the main latent classes of substances detected among overdose decedents, and latent class associations with age, sex, race, and jurisdiction of death in Maryland. Methods: We used toxicology data from the Office of the Chief Medical Examiner of Maryland for all decedents. We analyzed all cases of drug overdose deaths that occurred from 2016 to 2018 (N ¼ 6566) using latent class analysis and regression. Results: Drug overdose deaths were concentrated in 2 of 24 counties in Maryland (Baltimore City and County). Fentanyl was involved in 71% of all drug overdose deaths, and the majority (76%) of these deaths included multiple substances. Three latent classes emerged:(1) fentanyl/heroin/cocaine (64%); (2) fentanyl/alcohol (18%); and(3) prescription drugs including opioids, benzodiazepines and antidepressants (18.0%). The fentanyl/heroin/cocaine class members were significantly younger (<30 years), female and White compared to the fentanyl/alcohol class, but more male and non-White than the prescription drugs class (all P < 0.05). Deaths in Baltimore City/ County were more likely than in other locations to involve fentanyl/ alcohol (P < 0.05). Conclusions: The majority of fentanyl-involved overdose deaths in Maryland involved multiple substances, and several demographic and geographic differences in these patterns emerged. Geographically-targeted interventions that are tailored to reduce the harms associated with polysubstance use (including cocaine, alcohol, and prescription drugs) for different demographic groups are warranted.

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“…Cocaine is also commonly adulterated with substances such as levamisole (Brunt et al, 2017; Energy Control, 2017). In recent years, drugs such as cocaine have also been found to be adulterated or contaminated with fentanyl or its analogs (Armenian et al, 2019), so increased attention is needed toward what purported drugs actually contain in order to help prevent adverse outcomes related to unintentional exposure to such adulterants.…”

Section: Drug Checking At Dance Festivalsmentioning

confidence: 99%

Drug checking at dance festivals: A review with recommendations to increase generalizability of findings.

Palamar¹,

Fitzgerald²,

Keyes³

et al. 2021

Experimental and Clinical Psychopharmacology

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Dance festival attendees are at high risk for consuming adulterated drugs. In recent years, drug checking studies have been conducted at various dance festivals to provide valuable harm reduction information to attendees regarding drug content. We conducted a review of the literature to determine the generalizability of findings to the target population of interest-festival attendees at risk for using adulterated drugs. Six published studies involving drug checking at festivals were reviewed. All relied on self-selected samples and male attendees were overrepresented based on previous research. Test methods, drugs tested, definitions of adulteration, and prevalence of adulteration varied across studies. Prevalence of detection of adulterants ranged from 11% to 55%. While the drug checking services described appear to have been beneficial for participants, results have limited generalizability to the target population. We recommend that researchers expand beyond the self-selection model in future studies and utilize recruitment methods that involve random sampling techniques such as systematic random sampling, stratified random sampling, or timespace sampling within festivals. We also recommend that individuals approached are surveyed for demographic characteristics, planned drug use at the festival, and willingness to test their drugs. These methods would help determine how representative the sample is compared to the target population and allow for more generalizable estimates. In conclusion, as these valuable harm reduction services expand, it may be possible to reach a wider portion of the population at risk and to obtain more generalizable estimates of engagement, adulteration, and reactions to learning one possesses adulterated drugs. Public Health SignificanceDrug checking studies have been conducted at dance festivals to provide valuable harm reduction information to attendees regarding drug content. We conducted a review of the literature to determine the generalizability of findings to the target population of interest and determined that results have limited generalizability. We recommend that researchers expand beyond the self-selection model in future studies and utilize recruitment methods that involve random sampling techniques.

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Notes from the Field: Unintentional Fentanyl Overdoses Among Persons Who Thought They Were Snorting Cocaine — Fresno, California, January 7, 2019

Cited by 23 publications

References 5 publications

Age‐based preferences for risk communication in the fentanyl era: ‘A lot of people keep seeing other people die and that's not enough for them’

Age‐based preferences for risk communication in the fentanyl era: ‘A lot of people keep seeing other people die and that's not enough for them’

Polysubstance Overdose Deaths in the Fentanyl Era: A Latent Class Analysis

Drug checking at dance festivals: A review with recommendations to increase generalizability of findings.

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