Opioid users fear accidental overdoses from street drugs laced with fentanyl, but unpredictable drug quality means they often lack reliable strategies to avoid it, according to a team of researchers who suggest that fentanyl test strips may reduce overdose deaths.
"The opioid crisis is one of the biggest issues in the United States right now," said Ashton Verdery, assistant professor of sociology, demography, and social data analytics at Penn State. "Attention to fentanyl as a unique and blended component of the opioid crisis is absolutely imperative. It is separate from issues of heroin consumption and prescription pill consumption. It's a unique threat."
Illicit drug manufacturers often add fentanyl —a synthetic opioid — to heroin and counterfeit prescription pills because it is cheap to produce. In this unregulated market, fentanyl concentration can fluctuate between batches, with potentially dangerous consequences for users who are unaware of its presence. Because the fentanyl is vastly more potent than morphine or heroin, even small amounts can cause overdoses.
"I think that fentanyl-related deaths are a somewhat understudied topic in general," said Verdery. "Getting a handle on what leads to overdoses from fentanyl and ways to prevent it, I think, are critical research initiatives."
In a paper recently published in Substance Use & Misuse, the researchers reported attitudes around opioid use in southwest Pennsylvania.
"We were motivated (to do the research) by the sudden and dramatic involvement of fentanyl in overdose deaths, particularly in southwest Pennsylvania," said Katherine McLean, assistant professor of administration of justice at Penn State Greater Allegheny and lead author of the study. "Data from Allegheny County — the residence of the majority of our respondents — show that fentanyl was implicated in nearly 70 percent of overdose deaths in 2017."
Using surveys and unstructured interviews, the researchers found that many opioid users believed they had been exposed to fentanyl in the last year. Most participants were concerned about the danger of fentanyl and attempted to avoid it by purchasing from trusted suppliers, declining to use suspect heroin or eschewing heroin in favor of prescription opioids. However, the researchers point out that most of these strategies are limited by the user's knowledge of drug content or access to the same dealer.
A surprising finding of the study, according to McLean, was that some participants expressed a preference for fentanyl. Although these users sought out fentanyl, seeing it as a less-risky or more cost-effective drug, they also felt that a lack of information stymied their ability to administer safe drug doses.
The researchers suggest that pre-consumption fentanyl-testing strips could be an important tool for managing the current opioid crisis.
"The risks or danger of fentanyl are exacerbated by a social context in which people are often unaware of its presence, or concentration, in the drugs they consume," said McLean. "Empowering individuals with the tools to at least identify fentanyl might lower the incidence of accidental overdose among people that both want, and want to avoid, fentanyl."
Fentanyl has also contaminated the supply of other drugs such as cocaine.
"There is substantial evidence that fentanyl is infiltrating the broader drug supply," said Verdery. "Cocaine overdose deaths have increased dramatically, and fentanyl might be a big part of that. The broader availability of fentanyl makes the use of drugs more risky and uncertain. If people at least know what they're getting, they have the ability to make more informed choices, and I think that this is a valid harm-reduction strategy."
The researchers are planning a larger-scale study on patterns of fentanyl use with more participants and a broader geographical focus.
Other researchers working on the project were Shannon Monnat, associate professor of sociology at Syracuse University; Khary Rigg, assistant professor of mental health law and policy at the University of South Florida; and Glenn Sterner, assistant professor of criminal justice at Penn State Abington.
The Social Science Research Institute at Penn State, the Justice Center for Research at Penn State, the USDA Agriculture and Food Research Initiative Program and the Population Research Institute funded this research.