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

被引:192
作者
Carroll, Jennifer J. [1 ,2 ]
Marshall, Brandon D. L. [3 ]
Rich, Josiah D. [1 ,2 ,3 ]
Green, Traci C. [1 ,3 ,4 ]
机构
[1] Brown Univ, Warren Alpert Sch Med, 222 Richmond St, Providence, RI 02903 USA
[2] Miriam Hosp, Div Infect Dis, 164 Summit Ave, Providence, RI 02906 USA
[3] Brown Univ, Sch Publ Hlth, Dept Epidemiol, 121 South Main St,Box G-S-121-2, Providence, RI 02912 USA
[4] Boston Univ, Dept Emergency Med, Sch Med, 771 Albany St,Room 1208, Boston, MA 02118 USA
基金
美国国家卫生研究院; 美国医疗保健研究与质量局;
关键词
Fentanyl; Medication assisted treatment; Medications for addiction treatment; Overdose; Heroin; Drug use; Qualitative methods; BUPRENORPHINE-NALOXONE; PARTNER NOTIFICATION; DRUG-USERS; DEATHS; TRIAL; DEPENDENCE; BALTIMORE; METHADONE; MARYLAND; OUTCOMES;
D O I
10.1016/j.drugpo.2017.05.023
中图分类号
R194 [卫生标准、卫生检查、医药管理];
学科分类号
摘要
Background: Illicit fentanyl use has become wide spread in the US, causing high rates of overdose deaths among people who use drugs. This study describes patterns and perceptions of fentanyl exposure among opioid users in Rhode Island. Methods: A mixed methods study was conducted via questionnaire with a convenience sample of 149 individuals using illicit opioids or misusing prescription opioids in Rhode Island between January and November 2016. Of these, 121 knew of fentanyl and reported known or suspected exposure to fentanyl in the past year. Semi-structured interviews were conducted with the first 47 participants. Results: Study participants were predominantly male (64%) and white (61%). Demographic variables were similar across sample strata. Heroin was the most frequently reported drug of choice (72%). Self-reported exposure to illicit fentanyl in the past year was common (50.4%, n = 61). In multivariate models, regular (at least weekly) heroin use was independently associated with known or suspected fentanyl exposure in the past year (adjusted prevalence ratio (APR) = 4.07, 95% CI: 1.24-13.3, p = 0.020). In interviews, users described fentanyl as unpleasant, potentially deadly, and to be avoided. Participants reporting fentanyl exposure routinely experienced or encountered non-fatal overdose. Heroin users reported limited ability to identify fentanyl in their drugs. Harm reduction strategies used to protect themselves from fentanyl exposure and overdose, included test hits, seeking prescription opioids in lieu of heroin, and seeking treatment with combination buprenorphine/naloxone. Participants were often unsuccessful in accessing structured treatment programs. Conclusion: Among illicit opioid users in Rhode Island, known or suspected fentanyl exposure is common, yet demand for fentanyl is low. Fentanyl-contaminated drugs are generating user interest in effective risk mitigation strategies, including treatment. Responses to the fentanyl epidemic should be informed by the perceptions and experiences of local users. The rapid scale-up of buprenorphine/naloxone provision may slow the rate of fentanyl-involved overdose deaths. (c) 2017 The Authors. Published by Elsevier B.V.
引用
收藏
页码:136 / 145
页数:10
相关论文
共 37 条
[1]   Why the FUSS (Fentanyl Urine Screen Study)? A cross-sectional survey to characterize an emerging threat to people who use drugs in British Columbia, Canada [J].
Amlani, Ashraf ;
McKee, Geoff ;
Khamis, Noren ;
Raghukumar, Geetha ;
Tsang, Erica ;
Buxton, Jane A. .
HARM REDUCTION JOURNAL, 2015, 12
[2]   French field experience with buprenorphine [J].
Auriacombe, M ;
Fatséas, M ;
Dubernet, J ;
Daulouède, JP ;
Tignol, J .
AMERICAN JOURNAL ON ADDICTIONS, 2004, 13 :S17-S28
[3]   Illicit Use of Buprenorphine/Naloxone Among Injecting and Noninjecting Opioid Users [J].
Bazazi, Alexander R. ;
Yokell, Michael ;
Fu, Jeannia J. ;
Rich, Josiah D. ;
Zaller, Nickolas D. .
JOURNAL OF ADDICTION MEDICINE, 2011, 5 (03) :175-180
[4]   Abuse liability of prescription opioids compared to heroin in morphine-maintained heroin abusers [J].
Comer, Sandra D. ;
Sullivan, Maria A. ;
Whittington, Robert A. ;
Vosburg, Suzanne K. ;
Kowalczyk, William J. .
NEUROPSYCHOPHARMACOLOGY, 2008, 33 (05) :1179-1191
[5]   Emergency Department-Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence A Randomized Clinical Trial [J].
D'Onofrio, Gail ;
O'Connor, Patrick G. ;
Pantalon, Michael V. ;
Chawarski, Marek C. ;
Busch, Susan H. ;
Owens, Patricia H. ;
Bernstein, Steven L. ;
Fiellin, David A. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2015, 313 (16) :1636-1644
[6]   Achieving Integration in Mixed Methods Designs-Principles and Practices [J].
Fetters, Michael D. ;
Curry, Leslie A. ;
Creswell, John W. .
HEALTH SERVICES RESEARCH, 2013, 48 (06) :2134-2156
[7]   Fentanyl use among street drug users in Toronto, Canada: Behavioural dynamics and public health implications [J].
Firestone, Michelle ;
Goldman, Brian ;
Fischer, Benedikt .
INTERNATIONAL JOURNAL OF DRUG POLICY, 2009, 20 (01) :90-92
[8]  
Flynn R., 2016, NEW HAVEN REGISTER
[9]  
Glaser B. G., 1965, Awareness of dying
[10]   Research as due diligence: What can supply-side interventions accomplish and at what cost? [J].
Greenfield, Victoria A. ;
Paoli, Letizia .
INTERNATIONAL JOURNAL OF DRUG POLICY, 2017, 41 :162-163