SAN DIEGO – Many opioid users on the street are embracing homegrown “risk reduction” techniques to make sure they avoid the danger of fentanyl-laced heroin, while others seek out batches that have caused fatal overdoses because they figure these supplies must be extra-strong and desirable. “Anytime I hear that somebody OD’d off something,” said one user, “... I was like, ‘Oh, that stuff must be good. Where can I get it?’ ”
So say opioid users who are opening up to researchers about the deadly new American drug landscape.
There’s one common thread, said Daniel Ciccarone, MD, MPH, who presented findings from his team’s interviews at the annual meeting of the College on Problems of Drug Dependence. Attitudes about fentanyl are shifting, but not enough to turn the drug – which often is available instead of heroin – into a major crowd-pleaser.
Dr. Daniel Ciccarone
“When we first went into the field, there was a strong negative opinion about fentanyl. It was not wanted; it was imposed,” said Dr. Ciccarone of the University of California at San Francisco. “While there is some shift now, in which some do want or like the fentanyl, it is not strong enough to have shifted the culture. i.e., .”
But fentanyl still is rampant, often making its way to users who do not want and might be actively trying to avoid it. According to the National Institute on Drug Abuse, or NIDA, fentanyl and fentanyl analogs were linked to more than 20,000 of the more than 64,000 fatal U.S. drug overdoses in 2016.
“The risks are greater with fentanyl and not just because it is more potent than heroin,” Dr. Ciccarone said. In addition, “the form (fentanyl vs. fentanyl analogs) and purity shifts on a daily basis, and it’s mixed with heroin in varying amounts. It is these vicissitudes in fentanyl/heroin types and purities that make the street blends dangerous for overdose.”
Dr. Ciccarone and his colleagues interviewed opioid users in Baltimore; Charleston, W. Va.; Lawrence and Lowell, Mass.; and Chicago. Information about some of the interviews was published previously (Intl J Drug Policy. 2017 Aug;46;146-55).
In another study whose results were released at the CPDD conference, researchers from Dartmouth College, Hanover, N.H., interviewed 76 opioid users (91% were white, average age was 34, half were female, and almost all had a history of substance abuse treatment).
Andrea Meier
Among the other findings of the studies:
- Some opioid users are shocked by the adulteration of heroin by fentanyl, and even dealers are surprised: “When we cut the dope, we don’t use fentanyl. The problem was that we were buying the dope already dirty with that, and we didn’t know it,” said a 42-year-old man from Lawrence, Mass.
- In the New Hampshire interviews, 84% of participants said fentanyl is the leading cause of overdose in the state. “Due to the fentanyl and the heroin, that’s how everyone that I know ended up passing away recently,” said one user.
- Also in New Hampshire, 84% of users interviewed said they’d used fentanyl before, accidentally in some cases. Also, study coauthor Andrea L. Meier said in an interview, “67% of users reported having a prescription for opioids in their lifetime due to some kind of illness or injury. Some were short-term prescriptions (injuries, C-sections, tooth extractions); others were prescribed long-term due to chronic pain or illness.”