Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities

Korthuis, P Todd; Cook, Ryan; Foot, Canyon; Leichtling, Gillian; Tsui, Judith I.; Stopka, Thomas J.; Leahy, Judith M.; Jenkins, Wiley D.; Baker, Robin; Chan, Brian; Crane, Heidi M.; Cooper, Hannah L.F.; Feinberg, Judith; Zule, William; Go, Vivian F.; Estadt, Angela T.; Nance, Robin M.; Smith, Gordon S.; Westergaard, Ryan P.; Ham, Brent Van; Brown, Randall; Young, April M.

doi:10.1001/jamanetworkopen.2022.26544

Cited by 45 publications

(29 citation statements)

References 37 publications

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“…These findings align with recent evidence that a high proportion of co-involved stimulant-opioid overdose occurs among individuals not intending to use opioids [ 38 ]. Rising rates of fentanyl adulteration and co-involved stimulant-opioid overdose [ 38 , 39 ] call for increased educational outreach about the risks of fentanyl in nonopioid substances [ 39 , 40 ] and wider access to robust drug checking services [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and context of fentanyl test strip use among syringe service clients in southern Wisconsin

Tilhou

Birstler

Baltes³

et al. 2022

Harm Reduct J

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Background Fentanyl adulteration of illicit drugs is a major driver of opioid-involved overdose in the USA. Fentanyl test strips are increasingly used by people who use drugs to check for fentanyl. However, little is known about factors that influence test strip use in this population. Methods In this mixed-methods study employing semi-structured open-ended interviews (n = 29) and a structured survey (n = 341), we examined characteristics associated with test strip use, characteristics of test strip use, and situational, logistical and psychosocial factors influencing test strip use. Respondents were recruited from a syringe service program in southern Wisconsin. Bivariate tests of association and multivariable logistic regression examined the relationship between respondent characteristics and test strip use. Summary statistics were used to describe how situational, logistical and psychosocial factors impact test strip use. Results Most respondents were male (59.6%), non-Hispanic white (77.4%), young (mean 35.7 years), reported heroin as their primary drug (70.7%), injection as their primary route (87.9%), and use ≥ 3 times daily (78.6%). In multivariable models, site, race and ethnicity, drug of choice, and seeking fentanyl were associated with test strip use. Among test strip users, 36.5% use them most of the time or more and 80.6% get positive results half the time or more. Among individuals reporting heroin, fentanyl, methamphetamine, or cocaine or crack cocaine at least once per month, 99.1%, 56.8%, 42.2%, and 55.7% reported testing these drugs, respectively. Test strip use is supported by information from suppliers, regular transportation, diverse distribution locations, recommendations from harm reduction staff, and having a safe or private place to use. Conclusions We found that individuals who use fentanyl test strips are more often non-Hispanic white, use heroin, and seek drugs with fentanyl relative to individuals without test strip use. Findings confirm high fentanyl penetration in the Wisconsin drug supply. Low rates of stimulant testing suggest inadequate awareness of fentanyl penetration. Findings support outreach to key populations, increased diversity of distributing locations, efforts to correct misperceptions about drug wasting, emphasis on pre-consumption testing, and the importance of adjunct behaviors to prevent overdose given high rates of intentional fentanyl use.

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Section: Discussionmentioning

confidence: 99%

Characteristics and context of fentanyl test strip use among syringe service clients in southern Wisconsin

Tilhou

Birstler

Baltes³

et al. 2022

Harm Reduct J

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“…At the same time, participants seemed to know very little about overdose prevention and response reduction strategies emerging from many more urban harm reduction efforts, such as use of naloxone and fentanyl test strips. This finding contributes to the growing body of research demonstrating U.S. trends of increased fentanyl in stimulants such as methamphetamines and cocaine [ 49 , 51 ], suggesting the need for overdose interventions tailored to address both opioids and stimulants, as well as polydrug use, in settings that are more rural and may lack harm reduction infrastructure [ 52 ].…”

Section: Discussionmentioning

confidence: 84%

I Don’t Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois

Walters

Felsher

Frank

et al. 2023

IJERPH

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Background: Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. Methods: Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods. Results: Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting and/or changing the route of transmission. Approximately half of persons who inject drugs sampled had heard of fentanyl test strips, however fentanyl test strip use was low. To reverse overdoses, participants reported using cold water baths. Use of naloxone to reverse overdose was low. Barriers to naloxone access and use included fear of arrest and opioid withdrawal. Conclusions: People who inject drugs understood fentanyl to be a potential contaminant in their drug supply and actively engaged in harm reduction techniques to try to prevent overdose. Interventions to increase harm reduction education and information about and access to fentanyl test strips and naloxone would be beneficial.

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“…motivations around social connectedness/belonging) may provide a qualitatively distinct experience for sexual minority men in general [ 26 , 34 , 39 ] the actual practice of injecting involves the same material realities [ 27 ]. Nonetheless, the higher preference for methamphetamine among GBMSM compared to other men suggests that different approaches to addressing drug-related matters of concern may be required, given its implications for varying risks of harms and differences in treatment availability [ 40 – 43 ]. Moreover, methamphetamine use among GBMSM has previously been associated with sexualised drug use [ 31 , 34 ] and additional measures may be required to moderate methamphetamine-related risk in these contexts.…”

Section: Discussionmentioning

confidence: 99%

“…Methamphetamine has recently overtaken heroin as the most commonly reported last injected drug in Australia [ 47 , 48 ] and drug treatment services may need to respond to this shift. To date, there is little evidence that fentanyl has penetrated the Australian drug market [ 47 , 49 ] as it has overseas [ 40 , 50 ], but concomitant use of methamphetamine and opioids is common in both settings [ 51 – 53 ].…”

Section: Discussionmentioning

confidence: 99%

Does sexuality matter? A cross-sectional study of drug use, social injecting, and access to injection-specific care among men who inject drugs in Melbourne, Australia

et al. 2023

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Background Gay, bisexual and other men who have sex with men (GBMSM) are overrepresented in cohorts of people who inject drugs. GBMSM’s substance use is usually explored in the context of its contribution to sexual risk. We examined drug use practices, connectedness to other people who inject drugs, peer-to-peer injecting, and access to care among men who inject drugs in Melbourne, Australia. We aim to describe similarities and differences in these parameters for GBMSM and other men. Methods Data were drawn from a prospective cohort study of people who inject drugs conducted in Melbourne, Australia, since 2009. This cross-sectional study used data collected between 2016 and 2021. Descriptive statistics were used to assess differences between GBMSM and other men. Results Of 525 men who injected drugs over the study period, 48 (9%) identified as gay or bisexual, or reported sex with other men in the past 12 months. GBMSM and other men reported similar socio-demographics, drug practices (age of injecting initiation, most injected drug, peer-to-peer injecting, receptive syringe sharing) and access to injecting-specific care (drug treatment, source of needle-syringes). A significantly greater percentage of GBMSM reported past 12-month hepatitis C testing (69% vs. 52%, p = 0.028) and preferring methamphetamine (31% vs. 16%, p = 0.022). A higher percentage of GBMSM reported knowing > 50 other people who inject drugs (46% vs. 37%), but this difference was not statistically significant. Both groups primarily obtained injecting equipment from needle-syringe programs; a minority had accessed injecting-specific primary care. Conclusion Men who injected drugs in this cohort and those who identified as GBMSM reported similar drug and health-seeking practices. The higher prevalence of methamphetamine injecting among GBMSM may warrant different harm reduction support for this group. Health promotion should utilise opportunities to connect men who inject drugs in Melbourne to injecting-specific primary health care.

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Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities

Cited by 45 publications

References 37 publications

Characteristics and context of fentanyl test strip use among syringe service clients in southern Wisconsin

Characteristics and context of fentanyl test strip use among syringe service clients in southern Wisconsin

I Don’t Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois

Does sexuality matter? A cross-sectional study of drug use, social injecting, and access to injection-specific care among men who inject drugs in Melbourne, Australia

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