Engagement in Harm Reduction Strategies After Suspected Fentanyl Contamination Among Opioid-Dependent Individuals
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ORIGINAL PAPER
Engagement in Harm Reduction Strategies After Suspected Fentanyl Contamination Among Opioid‑Dependent Individuals Colleen B. Mistler1,2 · Divya K. Chandra3 · Michael M. Copenhaver1,2 · Jeffrey A. Wickersham2,3 · Roman Shrestha2,3 Accepted: 19 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The evolving opioid epidemic in the United States has increased drug-related overdose rates exponentially (Centers for Disease Control and Prevention in Opioid overdose, 2020c, https://www.cdc.gov/drugoverdose/data/otherdrugs.html#:~:text=Polys ubstance%20drug%20use%20occurs%20with,or%20other%20non%2Dopioid%20substances). Fentanyl, a synthetic opioid, has recently fueled the epidemic, increasing overdose death rates (Centers for Disease Control and Prevention in Drug overdose deaths involving fentanyl, 2011-2016, 2019a, https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_03-508.pdf). Harm reduction strategies (drug checking, naloxone administration, etc.) are at the forefront of preventing opioid-related overdoses in high-risk populations (Kennedy et al. in Drug Alcohol Depend 185:248–252, 2018, https://doi.org/10.1016/j. drugalcdep.2017.12.026; Laing et al. in Int J Drug Policy 62:59–66, 2018, https://doi.org/10.1016/j.drugpo.2018.10.001). Little is known, however, about how people who inject drugs (PWID) may modify their drug use behaviors after suspected fentanyl contamination in their drugs. We conducted a cross-sectional survey among 105 opioid-dependent PWID enrolled in a methadone maintenance program. We assessed their willingness to engage in various harm reduction methods (i.e., slowing down drug use, not using drugs, carrying naloxone, using with someone who has naloxone) after suspected fentanyl contamination of their drugs. In a multivariable analysis, participants who were white, low-income, polysubstance users, and had previously experienced an overdose or had previously administered naloxone were more likely to report a willingness to engage in harm reduction measures. These findings provide an evidence-based understanding of PWID’s engagement in harm reduction behaviors after suspecting potential fentanyl exposure as well as a basis for tailoring intervention strategies in the context of fentanyl-adulterated markets. Keywords People who inject drugs · Opiate agonist therapy · Fentanyl · Overdose · Methadone maintenance treatment · Harm reduction strategies
Introduction The United States has experienced an exponential increase in the rate of drug overdose in the past 20 years, with the opioid epidemic contributing to nearly half a million overdose deaths since 1999 [1]. The beginning of the epidemic * Colleen B. Mistler [email protected] 1
Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT 06269‑1101, USA
2
Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
3
Section of Infectious Diseases,
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