Heroin uncertainties: Exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’

International Journal of Drug Policy

Volumn 46, Issue , 2017, Pages 146-155

  Ciccarone, Daniel ^a   Ondocsin, Jeff ^a   Mars, Sarah G ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Fentanyl; Heroin; Mortality; Opioids; Overdose; Qualitative research

Indexed keywords

DIAMORPHINE; FENTANYL;

ADULT; ARTICLE; ATTITUDE; CHEMICAL COMPOSITION; CHEMICAL MODIFICATION; CHEMICAL STRUCTURE; COST; DRUG EFFECT; DRUG OVERDOSE; DRUG POTENCY; ETHNIC DIFFERENCE; ETHNOGRAPHIC RESEARCH; FEMALE; HUMAN; MALE; MIDDLE AGED; PERCEPTION; PRIORITY JOURNAL; SKIN SENSATION; SUBSTANCE USE; TASTE; UNITED STATES; CHEMISTRY; COMPLICATION; DRUG CONTAMINATION; DRUG USE; HARM REDUCTION; HEROIN DEPENDENCE; INTERVIEW; MASSACHUSETTS; NEW HAMPSHIRE; OPIATE ADDICTION; PROCEDURES; PSYCHOLOGY; STATISTICS AND NUMERICAL DATA; SUBSTANCE ABUSE; UNCERTAINTY; YOUNG ADULT;

ADULT; DRUG CONTAMINATION; DRUG OVERDOSE; DRUG USERS; FEMALE; FENTANYL; HARM REDUCTION; HEROIN; HEROIN DEPENDENCE; HUMANS; INTERVIEWS AS TOPIC; MALE; MASSACHUSETTS; MIDDLE AGED; NEW HAMPSHIRE; OPIOID-RELATED DISORDERS; SUBSTANCE ABUSE DETECTION; UNCERTAINTY; UNITED STATES; YOUNG ADULT;

EID: 85025173605     PISSN: 09553959     EISSN: 18734758     Source Type: Journal    
DOI: 10.1016/j.drugpo.2017.06.004     Document Type: Article

References (70)

1. Algren, A.D., Monteilh, C.P., Punja, M., Schier, J.G., Belson, M., Hepler, B.R., et al. Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July 2005–May 2006). Journal of Medical Toxicology 9:1 (2013), 106–115, 10.1007/s13181-012-0285-4.
2. Associated Press, AP. (2017). Illicit-drug use ok in ‘safe’ site under Maryland bill. Last Modified February 17 2017 http://baltimore.cbslocal.com/2017/02/17/illicit-drug-use-ok-in-safe-site-under-maryland-bill/.
3. Australian Injecting & Illicit Drug Users League, AIVL, Injecting fentanyl — Minimising the risks. 2013, AIVL, Australia.
4. Ayres, W.A., Starsiak, M.J., Sokolay, P., The bogus drug: Three methyl & alpha methyl fentanyl sold as China White. Journal of Psychoactive Drugs 13:1 (1981), 91–93.
5. Centers for Disease Control and Prevention, US, Nonpharmaceutical fentanyl-related deaths — Multiple states, April 2005–March 2007. Morbidity and Mortality Weekly Report 57:29 (2008), 793–796.
6. Christopoulos, K.A., Olender, S., Lopez, A.M., Lekas, H.-M., Jaiswal, J., Mellman, W., et al. Retained in HIV care but not on antiretroviral treatment: A qualitative patient-provider dyadic study. PLoS Medicine, 12(8), 2015, 10.1371/journal.pmed.1001863.
7. Ciccarone, D., The political economy of heroin: Regional markets, practices and consequences. International Journal of Drug Policy 16:5 (2005), 289–290.
8. Ciccarone, D., Heroin in brown, black and white: Structural factors and medical consequences in the US heroin market. International Journal of Drug Policy 20:3 (2009), 277–282, 10.1016/j.drugpo.2008.08.003.
9. Ciccarone, D., Bourgois, P., Explaining the geographical variation of HIV among injection drug users in the United States. Substance Use and Misuse 38:14 (2003), 2049–2063.
10. Ciccarone, D., Unick, G.J., Cohen, J., Mars, S., Rosenblum, D., Nationwide increase in hospitalizations for heroin-related soft tissue infections: Associations with structural market conditions. Drug and Alcohol Dependence 163 (2016), 126–133, 10.1016/j.drugalcdep.2016.04.009.
11. Ciccarone, D., Bourgois, P., Injecting drugs in tight spaces: HIV, cocaine and collinearity in the Downtown Eastside, Vancouver, Canada. International Journal of Drug Policy 33 (2016), 36–43.
12. Ciccarone, D., Harris, M., Fire in the vein: Heroin acidity and its proximal effect on users’ health. International Journal of Drug Policy 26:11 (2015), 1103–1110, 10.1016/j.drugpo.2015.04.009.
13. Ciccarone, D., Unick, G.J., Kraus, A., Impact of South American heroin on the US heroin market 1993–2004. International Journal of Drug Policy 20:5 (2009), 392–401, 10.1016/j.drugpo.2008.12.001.
14. Cicero, T.J., Ellis, M.S., Surratt, H.L., Kurtz, S.P., The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry 71:7 (2014), 821–826.
15. Compton, W.M., Jones, C.M., Baldwin, G.T., Relationship between nonmedical prescription-opioid use and heroin use. New England Journal of Medicine 374:2 (2016), 154–163, 10.1056/NEJMra1508490.
16. Çoruh, B., Tonelli, M.R., Park, D.R., Fentanyl-induced chest wall rigidity. Chest 143:4 (2013), 1145–1146, 10.1378/chest.12-2131.
17. Darke, S., Hall, W., Weatherburn, D., Lind, B., Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug and Alcohol Dependence 54:2 (1999), 155–161.
18. Doe-Simkins, M., Walley, A.Y., Epstein, A., Moyer, P., Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opioid overdose. American Journal of Public Health 99:5 (2009), 788–791, 10.2105/AJPH.2008.146647.
19. Douglas, M. (1966), this edition 1984. Purity and danger. An analysis of the concepts of pollution and taboo. London UK and Boston, MA: Ark Paperbacks, Routledge and Kegan Paul.
20. Drug Enforcement Administration Diversion Control Division, US, National Forensic Laboratory Information System: Year 2015 Annual Report., 2016, Springfield, VA.
21. Drug Enforcement Administration, US. (2015a). DEA Issues Nationwide Alert on Fentanyl as Threat to Health and Public Safety. https://www.dea.gov/divisions/hq/2015/hq031815.shtml.
22. Drug Enforcement Administration, US, National forensic laboratory information system special report: Opiates and related drugs reported in NFLIS, 2009–2014., 2015, US Drug Enforcement Administration, Office of Diversion Control, Springfield, VA.
23. Drug Enforcement Administration, US, National Heroin Threat Assessment Summary. April 2015. DEA Intelligence Report., 2015, US Department of Justice, Washington DC.
24. Drug Enforcement Administration, US, The Heroin Signature Program and Heroin Domestic Monitor Reports 2014. DEA Intelligence Report.., 2016, US Department of Justice, Washington DC.
25. Drug Enforcement Administration, US, National Drug Threat Assessment 2015. 2016, US Department of Justice, Washington DC.
26. European Monitoring Centre for Drugs and Drug Addiction, EMCDDA. (2015). Fentanyl drug profile.
27. Fahnenstich, H., Steffan, J., Kau, N., Bartmann, P., Fentanyl-induced chest wall rigidity and laryngospasm in preterm and term infants. Critical Care Medicine 28:3 (2000), 836–839.
28. Foderaro, L. W. (2016). Ithaca's anti-heroin plan: Open a site to shoot heroin. The New York Times. https://www.nytimes.com/2016/03/23/nyregion/fighting-heroin-ithaca-looks-to-injection-centers.html?_r=0.
29. Frank, R.G., Pollack, H.A., Addressing the fentanyl threat to public health. New England Journal of Medicine 376:7 (2017), 605–607.
30. Gladden, R.M., Martinez, P., Seth, P., Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths—27 states, 2013–2014. Morbidity and Mortality Weekly Report 65:33 (2016), 837–843.
31. Gutman, D., Seattle, King County move to open nation's first safe injection sites for drug users. 2017, The Seattle Times.
32. Harris, K.J., Jerome, N.W., Fawcett, S.B., Rapid assessment procedures: A review and critique. Human Organization 56:3 (1997), 375–378.
33. Harris, M., Forseth, K., Rhodes, T., It's Russian roulette: Adulteration, adverse effects and drug use transitions during the 2010/2011 United Kingdom heroin shortage. International Journal of Drug Policy 26:1 (2015), 51–58.
34. Hedegaard, H., Chen, L.H., Warner, M., Drug-poisoning deaths involving heroin: United States, 2000–2013. 2015, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
35. Hibbs, J., Perper, J., Winek, C.L., An outbreak of designer drug-related deaths in Pennsylvania. JAMA 265:8 (1991), 1011–1013, 10.1001/jama.1991.03460080081037.
36. Korf, D., Nabben, T., Antenna: A multi-method approach to assessing new drug trends. Understanding and responding to drug use: The role of qualitative research, 2002, EMCDDA, Lisbon.
37. Kotsopoulos, N., AIDS Project Worcester to administer city's needle exchange program. 2016, Telegram http://www.telegram.com/article/20160201/NEWS/160209897.
38. Kram, T.C., Cooper, D.A., Allen, A.C., Behind the identification of China White. Analytic Chemistry 53:12 (1981), 1379A–1386A.
39. Mars, S.G., Fessel, J.N., Bourgois, P., Montero, F., Karandinos, G., Ciccarone, D., Heroin-related overdose: The unexplored influences of markets, marketing and source-types in the United States. Social Science & Medicine 140 (2015), 44–53, 10.1016/j.socscimed.2015.06.032.
40. Mars, S., Bourgois, P., Karandinos, G., Montero, F., Ciccarone, D., “Every ‘never’ I ever said came true”: Transitions from opioid pills to heroin injecting. International Journal of Drug Policy 25:2 (2014), 257–266.
41. Mars, S.G., Bourgois, P., Karandinos, G., Montero, F., Ciccarone, D., The textures of heroin: User perspectives on “Black Tar” and powder heroin in two US cities. Journal of Psychoactive Drugs 48:4 (2016), 270–278.
42. Massachusetts Department of Public Health, US. (2017). Data Brief: Opioid-related Overdose Deaths Among Massachusetts Residents.
43. Messac, L., Ciccarone, D., Draine, J., Bourgois, P., The good-enough science-and-politics of anthropological collaboration with evidence-based clinical research: Four ethnographic case studies. Social Science and Medicine 99 (2013), 176–186, 10.1016/j.socscimed.2013.04.009.
44. Mounteney, J., Leirvåg, S.-E., Providing an earlier warning of emerging drug trends: The føre var system. Drugs: Education, Prevention and Policy 11:6 (2004), 449–471.
45. National Drug Intelligence Center, US. (2001). Massachusetts Drug Threat Assessment.
46. Needle, R.H., Trotter, R.T., Singer, M., Bates, C., Bryan Page, J., Metzger, D., Marcelin, L.H., Rapid assessment of the HIV/AIDS crisis in racial and ethnic minority communities: An approach for timely community interventions. American Journal of Public Health 93:6 (2003), 970–979.
47. Potier, C., Laprévote, V., Dubois-Arber, F., Cottencin, O., Rolland, B., Supervised injection services: What has been demonstrated? A systematic literature review. Drug and Alcohol Dependence 145 (2014), 48–68.
48. Rhodes, T., Risk environments and drug harms: A social science for harm reduction approach. International Journal of Drug Policy 20:3 (2009), 193–201, 10.1016/j.drugpo.2008.10.003.
49. Rhodes, T., Stimson, G.V., Fitch, C., Ball, A., Renton, A., Rapid assessment, injecting drug use, the public health. The Lancet, 354(9172), 1999, 65.
50. Rosenblum, D., Montero, F., Bourgois, P., Mars, S., Karandinos, G., Unick, G.J., et al. Urban segregation and the US heroin market: A quantitative model of anthropological hypotheses from an inner-city drug market. International Journal of Drug Policy 25:3 (2014), 543–555, 10.1016/j.drugpo.2013.12.008.
51. Rudd, R.A., Seth, P., David, F., Scholl, L., Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. Morbidity and Mortality Weekly Report 65 (2016), 1445–1452.
52. Rudd, R.A., Aleshire, N., Zibbell, J.E., Gladden, R.M., Increases in drug and opioid overdose deaths—United States, 2000–2014. Morbidity and Mortality Weekly Report 64 (2016), 1378–1382.
53. Schroers, A., Drug checking: monitoring the contents of new synthetic drugs. Journal of Drug Issues 32:2 (2002), 635–646, 10.1177/002204260203200219.
54. Schumann, H., Erickson, T., Thompson, T.M., Zautcke, J.L., Scott Denton, J., Fentanyl epidemic in Chicago, Illinois and surrounding Cook County. Clinical Toxicology 46:6 (2008), 501–506, 10.1080/15563650701877374.
55. Seal, K.H., Downing, M., Kral, A.H., Singleton-Banks, S., Hammond, J.P., Lorvick, J., et al. Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: A survey of street-recruited injectors in the San Francisco Bay Area. Journal of Urban Health 80:2 (2003), 291–301, 10.1093/jurban/jtg032.
56. Seal, K.H., Thawley, R., Gee, L., Bamberger, J., Kral, A.H., Ciccarone, D., et al. Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: A pilot intervention study. Journal of Urban Health 82:2 (2005), 303–311, 10.1093/jurban/jti053.
57. Smialek, J.E., Levine, B., Chin, L., Wu, S.C., Jenkins, A.J., A fentanyl epidemic in Maryland 1992. Journal of Forensic Science 39:1 (1994), 159–164.
58. Somerville, N.J., O'Donnell, J., Gladden, R.M., et al. Characteristics of Fentanyl Overdose — Massachusetts, 2014–2016. Morbidity and Mortality Weekly Report 66 (2017), 382–386, 10.15585/mmwr.mm6614a2.
59. Sorge, R., Kershnar, S., Getting off right. A safety manual for injection drug users. 1998, Harm Reduction Coalition, New York, NY.
60. Strang, J., Griffiths, P., Gossop, M., Heroin in the United Kingdom: Different forms, different origins, and the relationship to different routes of administration. Drug and Alcohol Review 16:4 (1997), 329–337, 10.1080/09595239700186711.
61. Strang, J., Powis, B., Best, D., Vingoe, L., Griffiths, P., Taylor, C., et al. Preventing opiate overdose fatalities with take-home naloxone: Pre-launch study of possible impact and acceptability. Addiction 94:2 (1999), 199–204, 10.1046/j.1360-0443.1999.9421993.x.
62. Suzuki, J., El-Haddad, S., A review: Fentanyl and non-pharmaceutical fentanyls. Drug and Alcohol Dependence 171 (2017), 107–116, 10.1016/j.drugalcdep.2016.11.033.
63. Trotter, R.T., Needle, R.H., Goosby, E., Bates, C., Singer, M., A methodological model for rapid assessment, response and evaluation: The RARE Program in public health. Field Methods 13 (2001), 137–159.
64. Unick, G.J., Ciccarone, D., US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations. International Journal of Drug Policy 46 (2017), 112–119.
65. Unick, G.J., Rosenblum, D., Mars, S., Ciccarone, D., Intertwined epidemics: National demographic trends in hospitalizations for heroin- and opioid-related overdoses, 1993–2009. PLoS One, 8(2), 2013, e54496, 10.1371/journal.pone.0054496.
66. Unick, G., Rosenblum, D., Mars, S., Ciccarone, D., The relationship between US heroin market dynamics and heroin-related overdose, 1992–2008. Addiction 109:11 (2014), 1889–1898, 10.1111/add.12664.
67. United States Census Bureau, US. 2015. “Quick Facts ”. Available at https://www.census.gov/quickfacts/.
68. Walley, A.Y., Xuan, Z., Hackman, H.H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. BMJ, 346, 2013, 10.1136/bmj.f174.
69. Warner, M., Trinidad, J.P., Bastian, B.A., Miniño, A.M., Hedegaard, H., Drugs most frequently involved in drug overdose deaths: United States, 2010–2014. National Vital Statistics Reports 65:10 (2016), 1–15.
70. Zibbell, J. E. (2016). Personal Communication. February 8th 2016.