Mini-review: Harm reduction strategies among people who intentionally use fentanyl

Background: Most published studies aimed at curtailing the morbidity and mortality associated with the current U.S. opioid epidemic have focused on unintentional exposure to fentanyl through heroin, cocaine, and other substances. Yet, there is mounting evidence that the intentional use of fentanyl is a key contributor to the current epidemic. In this mini-review we will discuss the harm reduction methods employed by people who intentionally use fentanyl (PWIUF) from a handful of articles found through PubMed that included PWIUF that were published between January 2013 to January 2024. Results: The perceived harm reduction strategies included co-use of stimulants, dose reduction, buying from a trusted dealer, drug checking, conducting a test shot, carrying naloxone, using fentanyl with others, and switching from injection to another route of administration (e.g., smoking). Some of these harm reduction strategies are frequently used by persons who inject heroin but future research on the efficacy of these harm reduction strategies for fentanyl use is warranted. It is important to note that co-use of stimulants has been associated with an increase in overdose. Conclusion: Future research is needed to understand intentional fentanyl use, perceived harm reduction strategies and the efficacy of these strategies with the advent of stronger opioids. Future research about PWIUF should consider novel study designs such as the ecological momentary assessment for more granular observation of the use of harm reduction strategies.