Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
University of Connecticut School of Medicine, Farmington, Connecticut, USA.
Subst Use Misuse. 2021;56(7):979-987. doi: 10.1080/10826084.2021.1901931. Epub 2021 Mar 26.
: In recent years, opioid-related mortality has increased steadily in the United States. Fentanyl, a synthetic opioid, has been a primary driver of the current wave of overdose-related deaths. Little is known, however, about fentanyl use among opioid-dependent people who inject drugs (PWID). We, therefore, sought to characterize purposeful fentanyl use among PWID. A cross-sectional survey was administrated to 104 opioid-dependent PWID on methadone who self-reported drug- or sex-related risk behaviors. Participants were recruited between July 2018 and October 2019 from a methadone clinic in New Haven, Connecticut. Multivariable logistic regressions were used to identify independent correlates of purposeful fentanyl use. Overall, 43.2% and 22.1% of the participants reported any (lifetime) or recent (past 30 days) purposeful fentanyl use, respectively. Independent correlates of any purposeful fentanyl use were younger age (aOR= 0.94; = 0.021), recent daily injection (aOR= 3.52; = 0.047), recent cocaine use (aOR= 3.54; = 0.041), and moderate/severe depression (aOR= 3.82; = 0.028). Independent correlates of recent purposeful fentanyl use were moderate/severe depression (aOR= 10.94; = 0.031), recently sharing injection equipment (aOR= 2.96; = 0.044), and recently engaging in transactional sex (aOR= 3.60; = 0.026). These findings indicate that opioid-dependent PWID on methadone remain at increased risk for overdose given the high prevalence of ongoing purposeful fentanyl exposure. Interventions to reduce the harms associated with fentanyl use should target young PWID and active fentanyl users, with an emphasis on achieving adequate methadone dosage and screening and treating depression in methadone-maintained patients who preferentially seek fentanyl.
: 近年来，美国与阿片类药物相关的死亡率稳步上升。芬太尼是一种合成阿片类药物，是当前过量用药相关死亡浪潮的主要驱动因素。然而，人们对注射阿片类药物的药物依赖者（PWID）中芬太尼的使用知之甚少。因此，我们试图描述 PWID 中有意使用芬太尼的情况。这项横断面调查对 104 名在康涅狄格州纽黑文市的美沙酮诊所接受美沙酮治疗的阿片类药物依赖者 PWID 进行了药物或性行为相关风险行为的自我报告。参与者于 2018 年 7 月至 2019 年 10 月间招募。多变量逻辑回归用于确定有意使用芬太尼的独立相关因素。总体而言，分别有 43.2%和 22.1%的参与者报告称存在任何（终生）或最近（过去 30 天内）有意使用芬太尼。有意使用芬太尼的独立相关因素包括年龄较小（OR=0.94；P=0.021）、最近每天注射（OR=3.52；P=0.047）、最近使用可卡因（OR=3.54；P=0.041）和中重度抑郁（OR=3.82；P=0.028）。最近有意使用芬太尼的独立相关因素包括中重度抑郁（OR=10.94；P=0.031）、最近共用注射设备（OR=2.96；P=0.044）和最近从事易货性性行为（OR=3.60；P=0.026）。这些发现表明，鉴于持续有意暴露于芬太尼的高流行率，接受美沙酮治疗的阿片类药物依赖者 PWID 仍然面临更高的药物过量风险。减少与芬太尼使用相关的危害的干预措施应针对年轻的 PWID 和积极使用芬太尼的人，重点是确保美沙酮剂量充足，并对首选芬太尼的美沙酮维持患者进行筛查和治疗抑郁。
