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Preference for drugs containing fentanyl from a cross-sectional survey of people who use illicit opioids in three United States cities.
Drug Alcohol Depend. 2019 11 01; 204:107547.DA

Abstract

BACKGROUND

Death from fentanyl-related overdose is now a leading cause of mortality among US adults. We sought to characterize fentanyl preference among street-based people who use drugs (PWUD).

METHODS

Cross-sectional surveys were administered to PWUD (N = 308) who illicitly used heroin or prescription opioids in the prior six months. Recruitment occurred in 2017 in three US east coast cities with high overdose mortality: Baltimore, Boston, and Providence. Our main outcome was preference for fentanyl (yes/no); exposures included sociodemographics, drug use, and overdose history. Pearson's χ2, Shapiro-Wilk-Mann rank-sum tests, and tiered log-binomial regression determined sociodemographic and exposure-related factors associated with fentanyl preference.

RESULTS

Preference for nonmedical use of fentanyl was reported by 27% (n = 83) of the sample. Fentanyl preference was associated with non-Hispanic white race (adjusted risk ratio (ARR) = 1.68, 95% confidence interval (CI):1.18-2.40), daily illicit drug use (aRR = 2.2, CI:1.71-2.87), and overdose ≥1 year ago (aRR = 1.33, CI:1.18-1.50). Age (in decades; aRR = 0.77, CI:0.61-0.98) and overdose <1 year ago (aRR = 0.92, CI:0.87-0.97) were associated with a decreased likelihood of preference. In our model excluding sociodemographics, initiating opioid use with non-prescribed opioids was associated with fentanyl preference (aRR = 1.48, CI:1.26-1.73).

CONCLUSION

In three cities with high levels of opioid use and overdose, a quarter of street based PWUD reported preferring fentanyl. An opioid use age cohort effect and disproportionate access to prescription opioids by race could be contributing to preference. Frequency of opioid use, not route of administration, was associated with preference. Our data demonstrate the need to consider preferences for fentanyl when targeting services and interventions for PWUD.

Authors+Show Affiliations

Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA. Electronic address: kmorale4@jh.edu.Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA.Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31536877

Citation

Morales, Kenneth B., et al. "Preference for Drugs Containing Fentanyl From a Cross-sectional Survey of People Who Use Illicit Opioids in Three United States Cities." Drug and Alcohol Dependence, vol. 204, 2019, p. 107547.
Morales KB, Park JN, Glick JL, et al. Preference for drugs containing fentanyl from a cross-sectional survey of people who use illicit opioids in three United States cities. Drug Alcohol Depend. 2019;204:107547.
Morales, K. B., Park, J. N., Glick, J. L., Rouhani, S., Green, T. C., & Sherman, S. G. (2019). Preference for drugs containing fentanyl from a cross-sectional survey of people who use illicit opioids in three United States cities. Drug and Alcohol Dependence, 204, 107547. https://doi.org/10.1016/j.drugalcdep.2019.107547
Morales KB, et al. Preference for Drugs Containing Fentanyl From a Cross-sectional Survey of People Who Use Illicit Opioids in Three United States Cities. Drug Alcohol Depend. 2019 11 1;204:107547. PubMed PMID: 31536877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preference for drugs containing fentanyl from a cross-sectional survey of people who use illicit opioids in three United States cities. AU - Morales,Kenneth B, AU - Park,Ju Nyeong, AU - Glick,Jennifer L, AU - Rouhani,Saba, AU - Green,Traci C, AU - Sherman,Susan G, Y1 - 2019/08/23/ PY - 2019/04/16/received PY - 2019/07/13/revised PY - 2019/07/14/accepted PY - 2019/9/20/pubmed PY - 2020/7/28/medline PY - 2019/9/20/entrez KW - Drug preference KW - Fentanyl KW - Opioids KW - Overdose KW - People who use drugs SP - 107547 EP - 107547 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 204 N2 - BACKGROUND: Death from fentanyl-related overdose is now a leading cause of mortality among US adults. We sought to characterize fentanyl preference among street-based people who use drugs (PWUD). METHODS: Cross-sectional surveys were administered to PWUD (N = 308) who illicitly used heroin or prescription opioids in the prior six months. Recruitment occurred in 2017 in three US east coast cities with high overdose mortality: Baltimore, Boston, and Providence. Our main outcome was preference for fentanyl (yes/no); exposures included sociodemographics, drug use, and overdose history. Pearson's χ2, Shapiro-Wilk-Mann rank-sum tests, and tiered log-binomial regression determined sociodemographic and exposure-related factors associated with fentanyl preference. RESULTS: Preference for nonmedical use of fentanyl was reported by 27% (n = 83) of the sample. Fentanyl preference was associated with non-Hispanic white race (adjusted risk ratio (ARR) = 1.68, 95% confidence interval (CI):1.18-2.40), daily illicit drug use (aRR = 2.2, CI:1.71-2.87), and overdose ≥1 year ago (aRR = 1.33, CI:1.18-1.50). Age (in decades; aRR = 0.77, CI:0.61-0.98) and overdose <1 year ago (aRR = 0.92, CI:0.87-0.97) were associated with a decreased likelihood of preference. In our model excluding sociodemographics, initiating opioid use with non-prescribed opioids was associated with fentanyl preference (aRR = 1.48, CI:1.26-1.73). CONCLUSION: In three cities with high levels of opioid use and overdose, a quarter of street based PWUD reported preferring fentanyl. An opioid use age cohort effect and disproportionate access to prescription opioids by race could be contributing to preference. Frequency of opioid use, not route of administration, was associated with preference. Our data demonstrate the need to consider preferences for fentanyl when targeting services and interventions for PWUD. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/31536877/Preference_for_drugs_containing_fentanyl_from_a_cross_sectional_survey_of_people_who_use_illicit_opioids_in_three_United_States_cities_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(19)30316-3 DB - PRIME DP - Unbound Medicine ER -