“It wasn’t here, and now it is. It’s everywhere": fentanyl’s rising presence in Oregon’s drug supply

Abstract

Background Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade. Methods We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. Results PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. Conclusion PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD.

Escalating costs of self-injury mortality in the 21st century United States: an interstate observational study

“…This study did not factor in inter-period volatility in SIM trends, exemplified by an accelerated rate [ 8 ] emanating from the spread of illicit fentanyl-related drugs [ 16 ]. Moreover, it does not include increased opioid deaths that occurred from 2019 to 2021 across the country, especially in Western states [ 56 , 57 ]. Heterogeneity in medicolegal death investigations systems may have depressed SIM costs.…”

Emergence of fentanyl‐related deaths in Travis County, Texas and surrounding areas: A retrospective review of postmortem fentanyl‐related drug toxicities from 2020 to 2022

“…The opioid epidemic continues to pose a significant threat to the public nationwide and globally. Since approximately 2015, significant increases in fentanyl-related fatalities have been reported nationwide [21,[26][27][28][29][30][31], but especially in the Northeast and Midwest regions of the US [21,29]. Only recently has more toxicological information been published on the emergence of fentanyl and significant increases in fentanyl-related deaths in the Western [21,28,31] and Southern [27,32,33] regions of the US.…”

“…Aside from fentanyl, toxicology findings most observed with illicit powder and pills included cocaine, methamphetamine, benzodiazepines, and opiates/opioids. The most frequently reported illicit pills on scene included blue oxycodone pills with "M30" markings, commonly referred to as "dirty 30s," "fetties," or "30 blues" [31], and white rectangular illicit "Xanax" tablets marked with "G-3-7-2-2. "…”

“…Aside from fentanyl, toxicology findings most observed with illicit powder and pills included cocaine, methamphetamine, benzodiazepines, and opiates/opioids. The most frequently reported illicit pills on scene included blue oxycodone pills with “M30” markings, commonly referred to as “dirty 30s,” “fetties,” or “30 blues” [31], and white rectangular illicit “Xanax” tablets marked with “G‐3‐7‐2‐2.” Although seized drug analyses were not conducted, toxicology findings only found oxycodone in two of the reports of illicit oxycodone and alprazolam in only 41% of illicit “Xanax” scene findings. It should be noted that average co‐positivity rates of oxycodone with fentanyl were only 2.9% over this time.…”

Drug decriminalization, the introduction of fentanyl to drug markets, and fatal overdose in Oregon

“…3 Moreover, fear of arrest for drugs, drug paraphernalia, or outstanding warrants has been shown to deter timely calls to 911 during overdose events. 4 The sequelae of arrest and imprisonment further diminish health outcomes as they engender obstacles to care, stable employment, housing, and other social determinants of health. 5 In response to these concerns, many states have decriminalized the possession of selected federally scheduled substances (e.g., cannabis, psilocybin, buprenorphine), enacted Good Samaritan laws to shield people from arrest at the scene of an overdose when they seek help, 6 and lessened the severity of the punishment for crimes associated with drug possession.…”