“I probably got a minute”: Perceptions of fentanyl test strip use among people who use stimulants

Reed, Megan; Roth, Alexis M.; Tabb, Loni Philip; Groves, Allison K.; Lankenau, Stephen E.

doi:10.1016/j.drugpo.2021.103147

Cited by 35 publications

(24 citation statements)

References 47 publications

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“…As heroin becomes less available and access to prescribed pharmaceutical opioids more restricted, NPF domination in the local drug markets has significant implications for policy modifications to allow the expanded use of drug checking technologies to identify the presence of NPFs in street drugs [ 12 ]. Although there is growing use of fentanyl testing strips as a harm reduction tool to qualitatively identify fentanyl and some analogs to help individuals adopt safer drug use practices [ 37 – 39 ], there is a need for community-based drug checking services and use of more advanced technologies that can be reliable and specific in identifying emerging fentanyl analogs and other novel drugs [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“They say it’s fentanyl, but they honestly look like Perc 30s”: Initiation and use of counterfeit fentanyl pills

Daniulaityte

Sweeney

et al. 2022

Harm Reduct J

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Background Worsening of the overdose crisis in the USA has been linked to the continuing proliferation of non-pharmaceutical fentanyl (NPF). The recent wave of NPF spread in the USA has been fueled by an increased presence of counterfeit pills that contain NPF. This qualitative study aims to characterize the motivation and practices of counterfeit NPF pill initiation and use among individuals using illicit opioids in Arizona. Methods Between October 2020 and May 2021, semi-structured interviews were conducted with 22 individuals meeting the following eligibility criteria: (1) 18 years or older; (2) residence in Arizona; and (3) use of illicit opioids in the past 30 days and/or opioid use disorder treatment in the past 12 months. Participants were recruited through referrals by a harm reduction organization, craigslist ads, and referrals by other participants. Interviews were conducted virtually via Zoom. Qualitative interviews were transcribed and analyzed thematically using NVivo. Results Out of 22 participants, 64% were male, and 45% were ethnic minorities. Age ranged between 25 and 51 years old. Participants noted significant recent increases in the availability of counterfeit NPF pills (“blues,” “dirty oxys”) that were most commonly used by smoking. The majority indicated first trying NPF pills in the past year, and the first use often occurred in situations of reduced access to heroin or pharmaceutical opioids. Participant decisions to switch over to more frequent NPF pill use or to maintain some levels of heroin use were shaped by local drug availability trends and personal experiences with NPF effects. They were also influenced by conflicting views of social acceptability of pharmaceutical-like drugs, perceived harms of NPF in terms of overdose risks and increased difficulty of quitting, and perceived benefits of switching to the non-injection route of opioid administration (e.g., from injecting heroin to smoking NPF pills). Conclusion Our findings highlight the need for the implementation of novel policy, treatment, and harm reduction approaches to address the growing unpredictability of drug supply and NPF pill-specific risks, attitudes, and behaviors.

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Section: Discussionmentioning

confidence: 99%

“They say it’s fentanyl, but they honestly look like Perc 30s”: Initiation and use of counterfeit fentanyl pills

Daniulaityte

Sweeney

et al. 2022

Harm Reduct J

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“…[ 34 – 38 ] However, PWUD have also described barriers to using testing strips, such as concern about experiencing withdrawal if they have to delay use. [ 39 ] More robust evidence on the strips’ accuracy when used by PWUD to test their drugs prior to consumption is needed, [ 40 , 41 ] and this should be shared with SSPs. More research is needed assessing how PWUD respond to positive or negative fentanyl test strip results to inform and optimize messaging to PWUD about their use.…”

Section: Discussionmentioning

confidence: 99%

Responding to a surge in overdose deaths: perspectives from US syringe services programs

et al. 2022

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Background US overdose deaths have reached a record high. Syringe services programs (SSPs) play a critical role in addressing this crisis by providing multiple services to people who use drugs (PWUD) that help prevent overdose death. This study examined the perspectives of leadership and staff from a geographically diverse sample of US SSPs on factors contributing to the overdose surge, their organization’s response, and ongoing barriers to preventing overdose death. Methods From 2/11/2021 to 4/23/2021, we conducted semi-structured interviews with leadership and staff from 27 SSPs sampled from the North American Syringe Exchange Network directory. Interviews were transcribed and qualitatively analyzed using a Rapid Assessment Process. Results Respondents reported that increased intentional and unintentional fentanyl use (both alone and combined with other substances) was a major driver of the overdose surge. They also described how the COVID-19 pandemic increased solitary drug use and led to abrupt increases in use due to life disruptions and worsened mental health among PWUD. In response to this surge, SSPs have increased naloxone distribution, including providing more doses per person and expanding distribution to people using non-opioid drugs. They are also adapting overdose prevention education to increase awareness of fentanyl risks, including for people using non-opioid drugs. Some are distributing fentanyl test strips, though a few respondents expressed doubts about strips’ effectiveness in reducing overdose harms. Some SSPs are expanding education and naloxone training/distribution in the broader community, beyond PWUD and their friends/family. Respondents described several ongoing barriers to preventing overdose death, including not reaching certain groups at risk of overdose (PWUD who do not inject, PWUD experiencing homelessness, and PWUD of color), an inconsistent naloxone supply and lack of access to intranasal naloxone in particular, inadequate funding, underestimates of overdoses, legal/policy barriers, and community stigma. Conclusions SSPs remain essential in preventing overdose deaths amid record numbers likely driven by increased fentanyl use and COVID-19-related impacts. These findings can inform efforts to support SSPs in this work. In the face of ongoing barriers, support for SSPs—including increased resources, political support, and community partnership—is urgently needed to address the worsening overdose crisis.

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“…Because use of drugs like crack cocaine often happens in areas with other drug use (such as opioids) (Friedman et al, 2019), harm reduction programs should consider extending outreach efforts to include training people who use drugs other than opioids as potential "first responders" likely to witness an opioid overdose. Qualitative research indicates that people who use stimulants with a recent history of incarceration are likely to witness an overdose after their release (Reed et al, 2021). However, this same subpopulation may now be at risk of an overdose themselves.…”

Section: Discussionmentioning

confidence: 99%

“…These same programs should extend efforts to distribute fentanyl test strips, which can easily be used to test drugs for the presence or fentanyl, alongside naloxone. Recent research indicates that formerly incarcerated people who use stimulants would like to use fentanyl test strips (Reed et al, 2021). Further, programs should consider expanding outreach to include dealers, as these relationships are sometimes protective against overdose and may be one of the first contacts people have after release from prison or jail (Binswanger et al, 2012;Carroll et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Changes in overdose knowledge and attitudes in an incarcerated sample of people living with HIV

Reed

Siegler²,

Tabb

et al. 2021

IJPH

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Purpose The purpose of this paper is to present evaluation results. People exiting incarceration who use opioids are at an elevated risk for overdose following release. People living with HIV (PLWH) who use drugs are also at increased overdose risk. Overdose education and naloxone distribution (OEND) is an effective community-based intervention, but few OEND programs have been evaluated in a correctional setting and none have specifically targeted PLWH. Design/methodology/approach An OEND pilot program was implemented in the Philadelphia jail from December 2017 to June 2019. OEND was provided through an HIV case management program and naloxone given at release. Participants (n = 68) were assessed for changes in overdose knowledge and beliefs in their ability to respond to an overdose from baseline to one month later while still incarcerated. Other demographic variables were assessed via publicly available records and case manager chart abstraction. Findings A total of 120 incarcerated PLWH were OEND trained; 68 (56.7%) were still incarcerated one month later and received post-tests. The 68-person sample was predominantly male (79.4%) and Black (64.7%). One-fifth reported heroin use, a third reported cocaine use and nearly 2/3 reported use of any illegal drug on date of arrest. Among these 68, overdose knowledge and overdose attitudes improved significantly (p = 0.002 and p < 0.001, respectively). Originality/value OEND in correctional settings is feasible and knowledge and overdose attitudes improved significantly from baseline. OEND programs should be implemented within the general population of incarcerated people but, as with PLWH, can be extended to other vulnerable populations within correctional settings, such as persons with mental health conditions and a history of homelessness.

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“I probably got a minute”: Perceptions of fentanyl test strip use among people who use stimulants

Cited by 35 publications

References 47 publications

“They say it’s fentanyl, but they honestly look like Perc 30s”: Initiation and use of counterfeit fentanyl pills

“They say it’s fentanyl, but they honestly look like Perc 30s”: Initiation and use of counterfeit fentanyl pills

Responding to a surge in overdose deaths: perspectives from US syringe services programs

Changes in overdose knowledge and attitudes in an incarcerated sample of people living with HIV

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