Acceptability of implementing community-based drug checking services for people who use drugs in three United States cities: Baltimore, Boston and Providence

North America is experiencing a rising trend of opioid overdose exacerbated primarily in recent years through adulteration of the heroin supply with fentanyl and its analogues. The east coast of the United States has been particularly hard hit by the epidemic. In three east coast states of Maryland,...

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Bibliographic Details
Published in:The International journal of drug policy 2019-06, Vol.68, p.46-53
Main Authors: Sherman, Susan G., Morales, Kenneth B., Park, Ju Nyeong, McKenzie, Michelle, Marshall, Brandon D.L., Green, Traci Craig
Format: Article
Language:English
Subjects:
Adult
Baltimore
Boston
Cities
Community Pharmacy Services
Community-based programs
Drug abuse
Drug checking
Drug Contamination - prevention & control
Drug overdose
Drug policy
Drug use
Drug Users - psychology
Drugs
Female
Fentanyl
Fentanyl - analysis
Harm Reduction
Health Knowledge, Attitudes, Practice
Heroin
Heroin - analysis
High risk
Homeless people
Humans
Male
Middle Aged
Opiates
Opioid overdose
Opioids
Overdoses
People who use drugs
Prevention
Questionnaires
Rhode Island
Risk assessment
Toxicology
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Summary:North America is experiencing a rising trend of opioid overdose exacerbated primarily in recent years through adulteration of the heroin supply with fentanyl and its analogues. The east coast of the United States has been particularly hard hit by the epidemic. In three east coast states of Maryland, Massachusetts and Rhode Island, fentanyl has been detected in over half of all overdoses with available toxicology screens. To determine the acceptability of drug checking involving fentanyl test strips (FTS) or other technologies among those at high risk for overdose, we assessed correlates of intention to utilize such services and logistical preferences among people who use drugs (PWUD). Through FORECAST (the Fentanyl Overdose REduction Checking Analysis STudy), street-based PWUD (N = 334) were recruited in Baltimore, Maryland, Boston, Massachusetts, and Providence, Rhode Island. Questionnaires 7were administered from June to October 2017 and ascertained drug use, overdose history, fentanyl knowledge, and drug checking intent and logistical preferences. Pearson’s χ2 and logistic regression determined factors associated with drug checking intent. Overall, 84% were concerned about fentanyl, 63% had ever overdosed, and 42% had ever witnessed a fatal overdose. Ninety percent felt drug checking would help them prevent an overdose, the majority of those interested would utilize drug checking at least daily (54%). Factors independently associated with intent to use drug checking included: older age (aOR: 1.5, 95% CI: 1.3–1.8); homelessness (aOR: 0.6, 95% CI: 0.5–0.7); being non-white (aOR: 2.0, 95% CI: 1.0–4.0); witnessing ≥1 fatal overdose (aOR: 1.6, 95% CI:1.1–2.3); and suspected recent fentanyl exposure (aOR: 1.8, 95% CI: 1.1–3.1). The majority of PWUD endorsed drug checking for overdose prevention, with intent amplified by having witnessed a fatal overdose and recent fentanyl exposure. Drug checking should be part of a comprehensive approach to address the risks associated with the proliferation of fentanyl.
ISSN:0955-3959
1873-4758
DOI:10.1016/j.drugpo.2019.03.003