Sex Differences in Illicitly Manufactured Fentanyl Use: Prevalence and Sociodemographic, Health, and Environmental Correlates.

Objectives: Illegally manufactured fentanyl use (IMFU) constitutes a public health concern. Understanding sex differences in IMFU can help plan population-based interventions.

Methods: We utilized the 2022 National Survey on Drug Use and Health, a nationally representative sample of the noninstitutionalized US population, to examine sex differences in IMFU and how IMFU relates to sociodemographic and health characteristics. Bivariate and multivariate analyses were used to estimate adjusted odds ratios and 95% CIs.

Results: The weighted lifetime prevalence of IMFU was 0.78% among men and 0.44% among women. Men were at greater risk for IMFU than women across models. Among both sexes, IMFU was positively associated with middle age (26-46 years old) and negatively with Hispanic ethnicity, being married/separated or divorced, higher than high-school educational attainment, and higher incomes (>$75,000+). Among men only, living below the federal poverty level was associated with IMFU. Among women alone, IMFU was additionally associated with being White. In the multivariable model, for both sexes, IMFU was associated with being young-to-middle aged, White, male, and unmarried and having high school or lower education and low income, mental and physical health concerns, and greater availability of heroin.

Conclusions: Certain socioeconomic segments of the US population are at elevated risk for IMFU, particularly when heroin is available. Targeted interventions addressing these groups and their communities are needed, and improved support is needed to promote better mental and physical health.