“You Never Know What You’re Getting”: Opioid Users’ Perceptions of Fentanyl in Southwest Pennsylvania

Abstract

Background: Urban areas in the United States have experienced a dramatic surge in fentanyl overdose deaths since 2014, a trend affecting both larger and smaller metropolitan areas. Encompassing only 1.2 million residents, Allegheny County, Pennsylvania, nevertheless saw 412 fentanyl-involved deaths in 2016, a number surpassed only by New York City and Cook County (Chicago), Illinois. Objectives: This article seeks to describe opioid users’ perceptions of fentanyl in Allegheny and three adjacent counties; it further considers how the drug’s emergence shapes some users’ market behaviors and consumption practices. Methods: This article reports on qualitative interview data (N = 30) collected as part of a larger, multi-phase, mixed methods study (N = 125) among individuals reporting past-year prescription opioid misuse or heroin use in four southwest Pennsylvania Counties. Results: Most interviewees reported past-year suspected exposure to fentanyl, and many reported suffering or seeing suspected fentanyl overdoses. Where roughly one-third reported strategies for avoiding fentanyl, a small group of interviewees identified advantages to fentanyl, while still acknowledging its associated risks. Conclusions/Importance: Given users’ diverse opinions around fentanyl, the distribution of fentanyl test strips may represent an effective response to the current crisis.

Keywords:

• Fentanyl
• heroin
• prescription opioids
• overdose
• harm reduction

Disclosure statement

The authors have no conflicts of interest to disclose.

Additional information

Funding

This study was funded by the Social Science Research Institute at Penn State University, which is supported by an infrastructure grant by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD041025) and by the Justice Center for Research at Penn State University. Dr. Monnat acknowledges funding from the USDA National Institute of Food and Agriculture, Agricultural and Food Research Initiative Competitive Program, Agriculture Economics and Rural Communities, grant #2018-68006-27640. Dr. Verdery acknowledges funding from the Population Research Institute, which is supported by an infrastructure grant by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24-HD041025), and the Institute for CyberScience at Penn State University.