Suspected involvement of fentanyl in prior overdoses and engagement in harm reduction practices among young adults who use drugs

Abstract

Background: From 2011 to 2016, the United States has experienced a 55% increase in overall overdose deaths and a 260% increase in fatal fentanyl-related overdoses. Increasing engagement in harm reduction practices is essential to reducing the rate of fentanyl-related overdoses. This study sought to examine the uptake of harm reduction practices among young adults who reported recent drug use and who were recruited for a study to assess the utility and acceptability of rapid fentanyl test strips. Methods: Between May and October 2017, 93 young adults who reported drug use in the past 30 days were recruited through word of mouth, Internet advertising, and public canvasing. Participants completed an interviewer-administered survey that assessed participants’ sociodemographic and behavioral characteristics, suspected fentanyl exposure, and overdose history. We assessed harm reduction practices and other correlates associated with experiencing a suspected fentanyl-related overdose. Results: Of 93 eligible participants, 36% (n = 34) reported ever having experienced an overdose, among whom 53% (n = 18) suspected having experienced a fentanyl-related overdose. Participants who had ever experienced a fentanyl-related overdose were more likely to keep naloxone nearby when using drugs compared with those who had never experienced an overdose and those who had experienced an overdose that they did not suspect was related to fentanyl (P < .001). Additionally, experiencing a suspected fentanyl-related overdose was associated with having previously administered naloxone to someone else experiencing an overdose (P < .001). Conclusion: Those who had experienced a suspected fentanyl-related overdose were more likely to carry and administer naloxone. Future overdose prevention interventions should involve persons who have experienced a suspected fentanyl overdose and/or responded to an overdose in order to develop harm reduction programs that meet the needs of those at risk of an overdose.

Keywords:

• Fentanyl
• harm reduction
• overdose
• young adults

Acknowledgments

We would like to thank the study participants for their contributions to the research, as well as our researchers, students, and staff, including Conor Millard, Kobe Pereira, Giovannia Barbosa, Esther Manu, and William Goedel.

Author contributions

Jacqueline E. Goldman and Maxwell S. Krieger helped conduct the surveys. Jacqueline E. Goldman drafted the manuscript and approved the final manuscript for submission. Jacqueline E. Goldman conducted the statistical analyses, with support from Maxwell S. Krieger and Brandon D. L. Marshall.Maxwell S. Krieger, Jane A. Buxton, Mark Lysyshyn, Susan G. Sherman, Traci C.

Green, Edward Bernstein and Scott E. Hadland helped revise the manuscript and assist with critical interpretations of the findings. Brandon D. L. Marshall conceived the pilot study and approved the final manuscript for submission. All authors read the manuscript and revised it critically, providing important intellectual context. All authors approved the final version of the manuscript for submission.

Additional information

Funding

This pilot project was supported by Brown University’s Office of the Vice President for Research through a Research Seed Grant. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.