Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically

Abstract

Background The rate of overdose deaths caused by fentanyl-contaminated heroin (FCH) use is increasing rapidly in the United States. We examined risk factors for exposure to FCH and experiences with FCH use among young adult non-medical prescription opioids (NMPO) users. Methods We analyzed data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which enrolled young adults aged 18 to 29 reporting prior 30 day NMPO use between January 2015 and February 2016. Participants completed questionnaires ascertaining drug use patterns and risk behaviors, including FCH exposure. Logistic regression was used to assess factors associated with known or suspected FCH exposure. Results Of 199 participants, the median age was 25 (IQR: 22, 27), 130 (65.3%) were male, and 122 (61.3%) were of white, non-Hispanic race/ethnicity. In total, 22 (11%) reported known or suspected FCH exposure in the prior six months. Several drug use patterns and risk behaviors were associated with FCH exposure, including: regular heroin and cocaine use; diverted pharmaceutical fentanyl use in the prior six months; NMPO use to avoid withdrawal symptoms; longer duration of NMPO use; injection drug use; and prior overdose (all p<0.001). Among participants who reported 3 FCH exposure, 59% were unaware that their heroin was contaminated with fentanyl prior to last use, 59% reported that FCH provides a better high, and all recognized that fentanyl increases overdose risk. Conclusions Exposure to fentanyl-contaminated heroin is an emerging trend among young adult NMPO users in Rhode Island. Overdose prevention programs addressing FCH use are urgently needed.

Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study

“…Heroin users in Rhode Island are encountering illicitly made fentanyl and fentanyl analogs produced in clandestine labs, not the medical-grade drug (Mercado-Crespo et al, 2014). There is some evidence that chronic users of illicit or diverted opioids may prefer the physical effects of fentanyl to those of pure heroin (Comer, Sullivan, Whittington, Vosburg, & Kowalczyk, 2008; Greenwald, 2008), and may seek it out (Macmadu et al, 2017); however, with no drug quality information available to opioid consumers and a high local prevalence of fentanyl-related overdose, perceived desirability of fentanyl in Rhode Island currently appears low.…”

“…A recent study among young adults in the state who use prescription opioids non-medically found that 11% reported known or suspected fentanyl exposure through contaminated drugs in the past six months (Macmadu, Carroll, Hadland, Green, & Marshall, 2017), indicating that fentanyl is reaching a wide spectrum of opioid users in the region. However, without more knowledge about the local drug market and drug use behaviors in the context of pervasive fentanyl exposure, policy-makers are limited in their ability to identify andtarget the individuals at the greatest risk of overdose.…”

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

“…People who use opioids may prefer to use fentanyl as it is highly lipid-soluble, thus rapid-acting, and 40 times more potent at the opioid receptor than heroin, which results in fast onset euphoria and pain relief. Many PWID describe the experience as like heroin, but more intense (Amlani et al, 2015; Ciccarone, Ondocsin, & Mars, 2017; Macmadu, Carroll, Hadland, Green, & Marshall, 2017). Like heroin, fentanyl has a half-life of approximately 3-7 hours (Trescot, Datta, Lee, & Hansen, 2008), however, the duration of action of fentanyl is briefer, only 30-60 minutes for an intravenous injection, compared to 4-5 hours for heroin.…”

Being “hooked up” during a sharp increase in the availability of illicitly manufactured fentanyl: Adaptations of drug using practices among people who use drugs (PWUD) in New York City

“…Department of Justice Drug Enforcement Admnistration, 2017), fentanyl and its analogs are visually indiscernible from one another, making it difficult to detect differences between them without thorough laboratory testing (Suzuki & El-Haddad, 2017). Persons who use drugs (PWUD) are often unaware when drugs are “cut”, or mixed with fentanyl (Carroll, Marshall, Rich, & Green, 2017; Macmadu, Carroll, Hadland, Green, & Marshall, 2017; Mars, Ondocsin, & Ciccarone, 2017; Spies et al, 2016; Stogner, 2014). Consequently, use of drugs containing fentanyl have been linked to sharp increases in rates of opioid morbidity and mortality (Centers for Disease Control & Prevention, 2017; Daniulaityte et al, 2017; Katz, 2017; Marshall et al, 2017; O’Donnell, Halpin, Mattson, Goldberger, & Gladden, 2017; Rudd, Aleshire, Zibbell, & Gladden, 2016; Rudd, Seth, David, & Scholl, 2016; Slavova et al, 2017).…”