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Heroin uncertainties: Exploring users' perceptions of fentanyl-adulterated and -substituted 'heroin'.
Int J Drug Policy. 2017 08; 46:146-155.IJ

Abstract

BACKGROUND

The US is experiencing an unprecedented opioid overdose epidemic fostered in recent years by regional contamination of the heroin supply with the fentanyl family of synthetic opioids. Since 2011 opioid-related overdose deaths in the East Coast state of Massachusetts have more than tripled, with 75% of the 1374 deaths with an available toxicology positive for fentanyl. Fentanyl is 30-50X more potent than heroin and its presence makes heroin use more unpredictable. A rapid ethnographic assessment was undertaken to understand the perceptions and experiences of people who inject drugs sold as 'heroin' and to observe the drugs and their use.

METHODS

A team of ethnographers conducted research in northeast Massachusetts and Nashua, New Hampshire in June 2016, performing (n=38) qualitative interviews with persons who use heroin.

RESULTS

(1) The composition and appearance of heroin changed in the last four years; (2) heroin is cheaper and more widely available than before; and (3) heroin 'types' have proliferated with several products being sold as 'heroin'. These consisted of two types of heroin (alone), fentanyl (alone), and heroin-fentanyl combinations. In the absence of available toxicological information on retail-level heroin, our research noted a hierarchy of fentanyl discernment methods, with embodied effects considered most reliable in determining fentanyl's presence, followed by taste, solution appearance and powder color. This paper presents a new 'heroin' typology based on users' reports.

CONCLUSION

Massachusetts' heroin has new appearances and is widely adulterated by fentanyl. Persons who use heroin are trying to discern the substances sold as heroin and their preferences for each form vary. The heroin typology presented is inexact but can be validated by correlating users' discernment with drug toxicological testing. If validated, this typology would be a valuable harm reduction tool. Further research on adaptations to heroin adulteration could reduce risks of using heroin and synthetic opioid combinations.

Authors+Show Affiliations

Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Ave., MU-3E, Box 900, San Francisco, CA 94143-0900, United States. Electronic address: daniel.ciccarone@ucsf.edu.Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Ave., MU-3E, Box 900, San Francisco, CA 94143-0900, United States.Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Ave., MU-3E, Box 900, San Francisco, CA 94143-0900, United States.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28735775

Citation

Ciccarone, Daniel, et al. "Heroin Uncertainties: Exploring Users' Perceptions of Fentanyl-adulterated and -substituted 'heroin'." The International Journal On Drug Policy, vol. 46, 2017, pp. 146-155.
Ciccarone D, Ondocsin J, Mars SG. Heroin uncertainties: Exploring users' perceptions of fentanyl-adulterated and -substituted 'heroin'. Int J Drug Policy. 2017;46:146-155.
Ciccarone, D., Ondocsin, J., & Mars, S. G. (2017). Heroin uncertainties: Exploring users' perceptions of fentanyl-adulterated and -substituted 'heroin'. The International Journal On Drug Policy, 46, 146-155. https://doi.org/10.1016/j.drugpo.2017.06.004
Ciccarone D, Ondocsin J, Mars SG. Heroin Uncertainties: Exploring Users' Perceptions of Fentanyl-adulterated and -substituted 'heroin'. Int J Drug Policy. 2017;46:146-155. PubMed PMID: 28735775.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heroin uncertainties: Exploring users' perceptions of fentanyl-adulterated and -substituted 'heroin'. AU - Ciccarone,Daniel, AU - Ondocsin,Jeff, AU - Mars,Sarah G, Y1 - 2017/07/18/ PY - 2017/05/10/received PY - 2017/06/01/revised PY - 2017/06/12/accepted PY - 2017/7/25/pubmed PY - 2018/4/27/medline PY - 2017/7/25/entrez KW - Fentanyl KW - Heroin KW - Mortality KW - Opioids KW - Overdose KW - Qualitative research SP - 146 EP - 155 JF - The International journal on drug policy JO - Int J Drug Policy VL - 46 N2 - BACKGROUND: The US is experiencing an unprecedented opioid overdose epidemic fostered in recent years by regional contamination of the heroin supply with the fentanyl family of synthetic opioids. Since 2011 opioid-related overdose deaths in the East Coast state of Massachusetts have more than tripled, with 75% of the 1374 deaths with an available toxicology positive for fentanyl. Fentanyl is 30-50X more potent than heroin and its presence makes heroin use more unpredictable. A rapid ethnographic assessment was undertaken to understand the perceptions and experiences of people who inject drugs sold as 'heroin' and to observe the drugs and their use. METHODS: A team of ethnographers conducted research in northeast Massachusetts and Nashua, New Hampshire in June 2016, performing (n=38) qualitative interviews with persons who use heroin. RESULTS: (1) The composition and appearance of heroin changed in the last four years; (2) heroin is cheaper and more widely available than before; and (3) heroin 'types' have proliferated with several products being sold as 'heroin'. These consisted of two types of heroin (alone), fentanyl (alone), and heroin-fentanyl combinations. In the absence of available toxicological information on retail-level heroin, our research noted a hierarchy of fentanyl discernment methods, with embodied effects considered most reliable in determining fentanyl's presence, followed by taste, solution appearance and powder color. This paper presents a new 'heroin' typology based on users' reports. CONCLUSION: Massachusetts' heroin has new appearances and is widely adulterated by fentanyl. Persons who use heroin are trying to discern the substances sold as heroin and their preferences for each form vary. The heroin typology presented is inexact but can be validated by correlating users' discernment with drug toxicological testing. If validated, this typology would be a valuable harm reduction tool. Further research on adaptations to heroin adulteration could reduce risks of using heroin and synthetic opioid combinations. SN - 1873-4758 UR - https://www.unboundmedicine.com/medline/citation/28735775/Heroin_uncertainties:_Exploring_users'_perceptions_of_fentanyl_adulterated_and__substituted_'heroin'_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0955-3959(17)30167-6 DB - PRIME DP - Unbound Medicine ER -