海洛因的不确定性：探究使用者对掺有芬太尼和被芬太尼替代的“海洛因”的认知。

Heroin uncertainties: Exploring users' perceptions of fentanyl-adulterated and -substituted 'heroin'.

作者信息

Ciccarone Daniel, Ondocsin Jeff, Mars Sarah G

机构信息

Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Ave., MU-3E, Box 900, San Francisco, CA 94143-0900, United States.

出版信息

Int J Drug Policy. 2017 Aug;46:146-155. doi: 10.1016/j.drugpo.2017.06.004. Epub 2017 Jul 18.

DOI:10.1016/j.drugpo.2017.06.004

PMID:28735775

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5577861/

Abstract

BACKGROUND

The US is experiencing an unprecedented opioid overdose epidemic fostered in recent years by regional contamination of the heroin supply with the fentanyl family of synthetic opioids. Since 2011 opioid-related overdose deaths in the East Coast state of Massachusetts have more than tripled, with 75% of the 1374 deaths with an available toxicology positive for fentanyl. Fentanyl is 30-50X more potent than heroin and its presence makes heroin use more unpredictable. A rapid ethnographic assessment was undertaken to understand the perceptions and experiences of people who inject drugs sold as 'heroin' and to observe the drugs and their use.

METHODS

A team of ethnographers conducted research in northeast Massachusetts and Nashua, New Hampshire in June 2016, performing (n=38) qualitative interviews with persons who use heroin.

RESULTS

(1) The composition and appearance of heroin changed in the last four years; (2) heroin is cheaper and more widely available than before; and (3) heroin 'types' have proliferated with several products being sold as 'heroin'. These consisted of two types of heroin (alone), fentanyl (alone), and heroin-fentanyl combinations. In the absence of available toxicological information on retail-level heroin, our research noted a hierarchy of fentanyl discernment methods, with embodied effects considered most reliable in determining fentanyl's presence, followed by taste, solution appearance and powder color. This paper presents a new 'heroin' typology based on users' reports.

CONCLUSION

Massachusetts' heroin has new appearances and is widely adulterated by fentanyl. Persons who use heroin are trying to discern the substances sold as heroin and their preferences for each form vary. The heroin typology presented is inexact but can be validated by correlating users' discernment with drug toxicological testing. If validated, this typology would be a valuable harm reduction tool. Further research on adaptations to heroin adulteration could reduce risks of using heroin and synthetic opioid combinations.

摘要

背景

近年来，由于海洛因供应受到合成阿片类芬太尼家族的区域污染，美国正经历一场前所未有的阿片类药物过量流行。自2011年以来，东海岸马萨诸塞州与阿片类药物相关的过量死亡人数增加了两倍多，在1374例死亡病例中，75%的死者毒理学检测显示芬太尼呈阳性。芬太尼的效力比海洛因强30至50倍，它的存在使海洛因的使用更难以预测。为了解注射以“海洛因”出售的毒品的人群的认知和经历，并观察这些毒品及其使用情况，开展了一项快速人种学评估。

方法

2016年6月，一组人种学者在马萨诸塞州东北部和新罕布什尔州的纳舒厄进行了研究，对使用海洛因的人进行了38次定性访谈。

结果

（1）海洛因的成分和外观在过去四年中发生了变化；（2）海洛因比以前更便宜且更容易获得；（3）海洛因“类型”激增，有几种产品被当作“海洛因”出售。这些包括两种类型的海洛因（单独存在）、芬太尼（单独存在）以及海洛因-芬太尼混合物。在缺乏零售级海洛因的可用毒理学信息的情况下，我们的研究指出了芬太尼辨别方法的层级，其中身体反应在确定芬太尼是否存在时被认为最可靠，其次是味道、溶液外观和粉末颜色。本文根据使用者的报告提出了一种新的“海洛因”分类法。

结论

马萨诸塞州的海洛因有了新外观，并且被芬太尼广泛掺假。使用海洛因的人试图辨别被当作海洛因出售的物质，他们对每种形式的偏好各不相同。所呈现的海洛因分类法并不精确，但可以通过将使用者的辨别结果与药物毒理学检测结果相关联来进行验证。如果得到验证，这种分类法将成为一种有价值的减少伤害工具。对海洛因掺假适应性的进一步研究可以降低使用海洛因和合成阿片类药物混合物的风险。