How substance use preferences and practices relate to fentanyl exposure among people who use drugs in Rhode Island, USA

Leah C. Shaw , Katie B. Biello , Jane A. Buxton , Jacqueline E. Goldman , Scott E. Hadland , Susan G. Sherman , Yu Li , Alexandria Macmadu , Brandon D.L. Marshall
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Abstract

Background

Over 107,000 people died in the United States (U.S.) from drug overdose in 2022, with over one million overdose deaths since 1999. The U.S. drug market is characterized by a highly toxic, unregulated, and rapidly changing supply. Understanding the extent of exposure to fentanyl among people who use drugs (PWUD) will guide public health interventions aimed to decrease overdose.

Methods

We utilized baseline data from the Rhode Island Prescription and Illicit Drug Study, a randomized controlled trial of harm reduction-oriented interventions for PWUD in Rhode Island from 2020 to 2023. We evaluated sociodemographic and drug use-related covariates and examined fentanyl presence in urine drug testing (UDT). We built a classification and regression tree (CART) model to identify subpopulations with the highest likelihood of fentanyl presence in UDT.

Results

Among 446 participants, those with fentanyl present in UDT tended to be younger, non-Hispanic white, and had recently injected drugs (p<0.05 for all). The CART analysis demonstrated a large variation in sample sub-groups’ likelihood of fentanyl presence in UDT, from an estimated probability of 0.09 to 0.90. Expected recent fentanyl exposure was the most important predictor of fentanyl in UDT.

Conclusions

Univariate analyses and CART modeling showed substantial variation in the presence of fentanyl in UDT among PWUD. Harm reduction services for people actively injecting drugs and drug checking programs based on capacity-building, empowerment, and targeted towards those not yet engaged in services are urgently needed to support PWUD in navigating the current volatile drug supply.

美国罗德岛州吸毒者的药物使用偏好和习惯与芬太尼暴露的关系
背景2022 年,美国有超过 107,000 人死于吸毒过量,自 1999 年以来,因吸毒过量死亡的人数已超过 100 万。美国毒品市场的特点是毒性大、不受监管、供应变化快。了解吸毒者(PWUD)接触芬太尼的程度将为旨在减少用药过量的公共卫生干预措施提供指导。方法我们利用了罗德岛处方药和非法药物研究的基线数据,该研究是 2020 年至 2023 年针对罗德岛州吸毒者(PWUD)的以减少危害为导向的干预措施的随机对照试验。我们评估了社会人口学和药物使用相关协变量,并检查了尿液药物检测(UDT)中的芬太尼含量。我们建立了一个分类和回归树 (CART) 模型,以确定尿液毒品检测中出现芬太尼可能性最高的亚人群。结果在 446 名参与者中,尿液毒品检测中出现芬太尼的人往往更年轻、为非西班牙裔白人,并且最近注射过毒品(所有数据的 p<0.05)。CART 分析表明,样本亚群在 UDT 中出现芬太尼的可能性差异很大,估计概率从 0.09 到 0.90 不等。结论多元分析和 CART 建模显示,在注射吸毒者中,未干注射器中含有芬太尼的情况存在很大差异。目前迫切需要为积极注射毒品的人群提供减低伤害服务,以及基于能力建设和赋权的毒品检查计划,并以尚未参与服务的人群为目标,以帮助注射毒品的人群应对当前不稳定的毒品供应。
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来源期刊
Drug and alcohol dependence reports
Drug and alcohol dependence reports Psychiatry and Mental Health
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