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Erinoso O, Daugherty R, Kirk MR, Harding RW, Etchart H, Reyes A, Page K, Fiuty P, Wagner KD. Safety strategies and harm reduction for methamphetamine users in the era of fentanyl contamination: A qualitative analysis. Int J Drug Policy 2024; 128:104456. [PMID: 38761461 DOI: 10.1016/j.drugpo.2024.104456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION In the United States, methamphetamine use is increasing and the context of its use has changed, with reports of illicitly manufactured fentanyl being mixed with methamphetamine (either deliberately or inadvertently). We explore risk-mitigating actions taken by people who use drugs to protect their health when using methamphetamine in that context. METHODS We conducted qualitative interviews with 48 adults (18+) who used methamphetamine in the past three months at two sites in Nevada, USA and two sites in New Mexico, USA. Interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Respondents described two rationales for employing harm reduction strategies. First, to prevent harm from methamphetamine containing illicit fentanyl, and second, to maintain their general wellbeing while using methamphetamine. Regarding methamphetamine containing illicit fentanyl, our findings highlight how respondents employ primary strategies like buying from trusted sources and secondary strategies such as spotting and selective use of harm reduction tools (i.e., fentanyl test strips) to reduce risks. To maintain their general wellbeing, participants reduced their use of methamphetamine as reasonably as possible, and used other substances like marijuana and alcohol alongside methamphetamine to counter the unwanted side effects of methamphetamine (i.e., hallucinations and paranoia). Use of these harm reduction strategies varied within situational and social contexts, and respondents usually developed these strategies based on their lived experiences. CONCLUSION Our findings uniquely demonstrate that people who use methamphetamine prioritize community driven, trust-based strategies within their social networks to mitigate risks in a fentanyl-contaminated drug environment. Additionally, our results indicate that harm reduction behaviors are influenced by multilevel risk environments, which include social, physical, economic, and political factors. Overall, these results highlight the potential for targeted interventions at the network level, which are responsive to complexities and shifts in drug market dynamics- such as illicit fentanyl in methamphetamine.
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Affiliation(s)
- Olufemi Erinoso
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Robbie Daugherty
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Mia R Kirk
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Robert W Harding
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Haley Etchart
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Andres Reyes
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM, United States
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, NM, United States
| | - Phillip Fiuty
- New Mexico Health, Albuquerque, New Mexico, United States
| | - Karla D Wagner
- Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, United States.
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Palayew A, Banta-Green CJ, Lamont M, Damper D, Moreno C, Goodreau SM, Mooney SJ, Glick SN. Acceptability and anticipated effectiveness of a safe supply of opioids, among people who inject opioids in King County, WA. Int J Drug Policy 2024; 127:104389. [PMID: 38522176 DOI: 10.1016/j.drugpo.2024.104389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Opioid overdose mortality in the US has exceeded one million deaths over the last two decades. A regulated opioid supply may help prevent future overdose deaths by reducing exposure to the unregulated opioid supply. We examined the acceptability, delivery model preference, and anticipated effectiveness of different regulated opioid models among people in the Seattle area who inject opioids. METHODS We enrolled people who inject drugs in the 2022 Seattle-area National HIV Behavior Surveillance (NHBS) survey. Participants were recruited between July and December 2022 using respondent-driven sampling. Participants who reported injecting opioids (N = 453) were asked whether regulated opioids would be acceptable, their preferred model of receiving regulated opioids, and the anticipated change in individual overdose risk from accessing a regulated opioid supply. RESULTS In total, 369 (81 %) participants who injected opioids reported that a regulated opioid supply would be acceptable to them. Of the 369 who found a regulated opioid supply to be acceptable, the plurality preferred a take-home model where drugs are prescribed (35 %), followed closely by a dispensary model that required no prescription (28 %), and a prescribed model where drugs need to be consumed on site (13 %), a model where no prescription is required and drugs can be accessed in a community setting with a one-time upfront payment was the least preferred model (5 %). Most participants (69 %) indicated that receiving a regulated opioid supply would be "a lot less risky" than their current supply, 20 % said, "a little less risky", 10 % said no difference, and 1 % said a little or a lot more risky. CONCLUSION A regulated opioid supply would be acceptable to most participants, and participants reported it would greatly reduce their risk of overdose. As overdose deaths continue to increase in Washington state pragmatic and effective solutions that reduce exposure to unregulated drugs are needed.
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Affiliation(s)
- Adam Palayew
- Department of Epidemiology, School of Public Health, University of Washington, USA; VOCAL, Washington, USA.
| | - Caleb J Banta-Green
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, USA; Department of Health Systems and Population Health, School of Public Health, University of Washington, USA
| | - Malika Lamont
- VOCAL, Washington, USA; Public Defenders Association, Seattle, Washington, USA
| | | | - Courtney Moreno
- Public Health Seattle King County, Division of Infectious Diseases, Seattle, Washington, USA
| | - Steven M Goodreau
- Department of Anthropology, School of Public Health, University of Washington, USA
| | - Stephen J Mooney
- Department of Epidemiology, School of Public Health, University of Washington, USA
| | - Sara N Glick
- Department of Epidemiology, School of Public Health, University of Washington, USA; Public Health Seattle King County, Division of Infectious Diseases, Seattle, Washington, USA; Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, USA
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Tanz LJ, Gladden RM, Dinwiddie AT, Miller KD, Broz D, Spector E, O’Donnell J. Routes of Drug Use Among Drug Overdose Deaths - United States, 2020-2022. MMWR Morb Mortal Wkly Rep 2024; 73:124-130. [PMID: 38358969 PMCID: PMC10899081 DOI: 10.15585/mmwr.mm7306a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Preliminary reports indicate that more than 109,000 drug overdose deaths occurred in the United States in 2022; nearly 70% of these involved synthetic opioids other than methadone, primarily illegally manufactured fentanyl and fentanyl analogs (IMFs). Data from the western United States suggested a transition from injecting heroin to smoking IMFs. CDC analyzed data from the State Unintentional Drug Overdose Reporting System to describe trends in routes of drug use in 27 states and the District of Columbia among overdose deaths that occurred during January 2020-December 2022, overall and by region and drugs detected. From January-June 2020 to July-December 2022, the percentage of overdose deaths with evidence of injection decreased 29.1%, from 22.7% to 16.1%, whereas the percentage with evidence of smoking increased 73.7%, from 13.3% to 23.1%. The number of deaths with evidence of smoking increased 109.1%, from 2,794 to 5,843, and by 2022, smoking was the most commonly documented route of use in overdose deaths. Trends were similar in all U.S. regions. Among deaths with only IMFs detected, the percentage with evidence of injection decreased 41.6%, from 20.9% during January-June 2020 to 12.2% during July-December 2022, whereas the percentage with evidence of smoking increased 78.9%, from 10.9% to 19.5%. Similar trends were observed among deaths with both IMFs and stimulants detected. Strengthening public health and harm reduction services to address overdose risk related to diverse routes of drug use, including smoking and other noninjection routes, might reduce drug overdose deaths.
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Burke B, Clear B, Rollston RL, Miller EN, Weiner SG. An Assessment of the One-Month Effectiveness of Telehealth Treatment for Opioid Use Disorder Using the Brief Addiction Monitor. Subst Use Addctn J 2024; 45:16-23. [PMID: 38258856 DOI: 10.1177/29767342231212790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Telehealth treatment with medication for opioid use disorder (teleMOUD) was made possible with regulations following the COVID-19 pandemic that permitted prescribing buprenorphine without an in-person visit. This study evaluates the self-reported outcomes of patients treated by teleMOUD using the Brief Addiction Monitor (BAM), a 17-question tool that assesses drug use, cravings, physical and psychological health, and psychosocial factors to produce 3 subset scores: substance use, risk factors, and protective factors. METHODS Patients treated by a teleMOUD provider group operating in >30 states were asked to complete an app-based version of BAM at enrollment and at 1 month. Patients who completed both assessments between June 2022 and March 2023 were included. RESULTS A total of 2556 patients completed an enrollment BAM and 1447 completed both assessments. Mean number of days from baseline BAM to follow-up was 26.7 days. Changes were significantly different across most questions. The substance use subscale decreased from mean 2.6 to 0.8 (P < .001), the risk factors subscale decreased from mean 10.3 to 7.5 (P < .001), and the protective factors subscale increased from mean 14.3 to 15.0. (P < .001). Substance use and risk factor subscale changes were significant across all sex and age groups, while protective factors subscale did not improve for those <25 and >54 years. Patient reports of at least 1 day of illegal use or misuse decreased, including marijuana (28.1% vs 9.0%), cocaine/crack (3.9% vs 2.6%), and opioids (49.8% vs 10.5%). CONCLUSIONS Among patients treated by teleMOUD who completed assessments at enrollment and 1 month, there was improvement in drug use, risk factor, and protective factor scores.
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Affiliation(s)
| | | | - Rebekah L Rollston
- Bicycle Health, Boston, MA, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Scott G Weiner
- Bicycle Health, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Estadt AT, Miller WC, Kline D, Whitney BM, Young AM, Todd Korthuis P, Stopka TJ, Feinberg J, Zule WA, Pho MT, Friedmann PD, Westergaard RP, Eagen KV, Seaman A, Ma J, Go VF, Lancaster KE. Associations of hepatitis C virus (HCV) antibody positivity with opioid, stimulant, and polysubstance injection among people who inject drugs (PWID) in rural U.S. communities. International Journal of Drug Policy 2023:104222. [PMID: 37806839 PMCID: PMC10997735 DOI: 10.1016/j.drugpo.2023.104222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND People who inject drugs (PWID) in the rural U.S. often inject stimulants, alone or with opioids. The impact of these substance use patterns may influence HCV risk behaviors. This analysis examines the associations of HCV antibody positivity with injecting only opioids, only stimulants (methamphetamine/cocaine), and opioids and stimulants together among rural PWID. METHODS The Rural Opioid Initiative (ROI) consists of eight research sites that enrolled people who use drugs in rural communities in ten U.S. states from 2018 to 2020. This cross-sectional analysis included adult participants who resided in a study area and injected any drug in the past 30 days. The primary outcome was HCV antibody positivity. The exposure of interest was injection drug use classified as only opioids, only stimulants, separate injections of opioids and stimulants, and same-syringe injection of both in the past 30 days. We used multivariable log-binomial regression with generalized linear mixed models to generate prevalence ratios (P.R.) adjusted for demographics, injection history, health insurance, and substance use treatment. RESULTS Among 3,084 participants enrolled in the ROI, 1,982 met inclusion criteria. Most participants injected opioids and stimulants in the same syringe (34%) or separately (21%), followed by injecting only stimulants (26%), and injecting only opioids (19%). Half (51%) were HCV antibody positive. Compared to people who injected only stimulants, HCV antibody positivity was more prevalent among people who injected opioids alone (aPR=1.62, 95% CI:(1.29-2.03)), injected both opioids and stimulants separately (aPR=1.61, 95% CI:(1.32-1.95)), and in the same syringe (aPR=1.54, 95% CI:(1.28-1.85)). CONCLUSION HCV antibody positivity, indicating prior exposure, was highest among those who had recently injected opioids, alone or with stimulants. Additional nucleic acid testing is necessary to confirm active infection. More research is needed to determine the underlying causes of HCV antibody positivity by injection use.
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Affiliation(s)
- Angela T Estadt
- Ohio State University, College of Public Health, Division of Epidemiology, United States.
| | - William C Miller
- Ohio State University, College of Public Health, Division of Epidemiology, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - David Kline
- Wake Forest University School of Medicine, Division of Public Health Sciences, Department of Biostatistics and Data Science, United States
| | | | - April M Young
- University of Kentucky, Department of Epidemiology and Environmental Health, Center on Drug and Alcohol Research, United States
| | - P Todd Korthuis
- Oregon Health & Science University, Department of Medicine, Section of Addiction Medicine, United States
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, United States
| | - Judith Feinberg
- West Virginia University School of Medicine, Departments of Behavioral Medicine and Psychiatry and Medicine/Infectious Diseases, United States
| | - William A Zule
- RTI International, Research Triangle Park, NC, United States
| | - Mai T Pho
- University of Chicago, Department of Medicine, United States
| | - Peter D Friedmann
- University of Massachusetts Medical School-Baystate and Baystate Health, United States
| | - Ryan P Westergaard
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Infectious Diseases, United States
| | - Kellene V Eagen
- University of Wisconsin - Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, United States
| | - Andrew Seaman
- Oregon Health & Science University, School of Medicine, United States
| | - Jimmy Ma
- University of Washington, Department of Medicine, Division of Allergy and Infectious Diseases, United States
| | - Vivian F Go
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, United States
| | - Kathryn E Lancaster
- Ohio State University, College of Public Health, Division of Epidemiology, United States; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
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Daniulaityte R, Ruhter L, Juhascik M, Silverstein S. Attitudes and experiences with fentanyl contamination of methamphetamine: exploring self-reports and urine toxicology among persons who use methamphetamine and other drugs. Harm Reduct J 2023; 20:54. [PMID: 37081499 PMCID: PMC10118220 DOI: 10.1186/s12954-023-00782-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND There are growing concerns about illicitly manufactured fentanyl (IMF) contamination of methamphetamine. This study aims to characterize the lay views and experiences with IMF-contaminated methamphetamine (IMF/meth) and identify participants with unknown IMF exposures through urine toxicology analysis. METHODS Between December-2019 and November-2021, structured interviews were conducted with 91 individuals who reported past 30-day use of methamphetamine and resided in Dayton, Ohio, USA. Lab-based urine toxicology analyses were conducted to identify fentanyl/analogs, methamphetamine, and other drugs. Bivariate analyses were conducted to identify characteristics associated with attitudes and experiences with IMF/meth, and unknown IMF exposures. RESULTS The majority (95.6%) of the study participants were non-Hispanic white, and 52.7% were female. Past 30-day use of methamphetamine was reported on a mean of 18.7 (SD 9.1) days, and 62.6% also reported past 30-day use of heroin/IMF. Most (76.9%) had a history of an unintentional drug-related overdose, but 38.5% rated their current risk for an opioid overdose as none. Besides fentanyl (71.9%), toxicology analysis identified nine fentanyl analogs/metabolites (e.g., 42.7% acetyl fentanyl, 19.0% fluorofentanyl, 5.6% carfentanil), and 12.4% tested positive for Xylazine. The majority (71.4%) believed that IMF/meth was common, and 59.3% reported prior exposures to IMF/meth. 11.2% tested positive for IMF but reported no past 30-day heroin/IMF use (unknown exposure to IMF). Views that IMF/meth was common showed association with homelessness (p = 0.04), prior overdose (p = 0.028), and greater perceived risk of opioid overdose (p = 0.019). Self-reported exposure to IMF/meth was associated with homelessness (p = 0.007) and obtaining take-home naloxone (p = 0.025). Individuals with unknown IMF exposure (test positive for IMF, no reported past 30-day heroin/IMF use) were older (49.9 vs. 41.1 years, p < 0.01), and reported more frequent past 30-day use of methamphetamine (24.4 vs. 18.0 days, p < 0.05). They indicated lower perceived risk of opioid overdose (0.1 vs. 1.9, scale from 0 = "none" to 4 = "high," p < 0.001). DISCUSSION This study suggests a need for targeted interventions for people who use methamphetamine and expansion of drug checking and other harm reduction services.
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Affiliation(s)
- Raminta Daniulaityte
- College of Health Solutions, Arizona State University, 425 N 5Th Street, ABC 121, Phoenix, AZ, 85004, USA.
| | - Lance Ruhter
- College of Health Solutions, Arizona State University, 425 N 5Th Street, ABC 121, Phoenix, AZ, 85004, USA
| | - Matthew Juhascik
- Montgomery County Coroner's Office and Crime Laboratory, Dayton, OH, USA
| | - Sydney Silverstein
- Department of Population and Public Health Sciences, Center for Interventions, Treatment, and Addictions Research, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
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