RTI International, Berkeley, CA, United States.
RTI International, Berkeley, CA, United States; University of California, San Francisco, CA, United States; University of Washington, Seattle, WA, United States.
Drug Alcohol Depend. 2021 Oct 1;227:109003. doi: 10.1016/j.drugalcdep.2021.109003. Epub 2021 Aug 27.
The introduction of illicitly made fentanyl in the United States has slowly replaced heroin. New illicit drugs are often associated with changes in frequency and modes of administration. We assessed changes in injection frequency and smoking fentanyl in the new era of fentanyl availability in San Francisco.
We used targeted sampling to recruit 395 people who inject drugs (PWID) into an observational cohort study in San Francisco 2018-2020. We assessed changes in injection frequency, opioid injection frequency and fentanyl smoking frequency in four six-month periods. We also conducted qualitative interviews with PWID asking about motivations for injecting and smoking opioids.
The median number of past-month injections steadily decreased by semi-annual calendar year from 92 injections in July to December 2018 to 17 injections in January to June 2020. The rate of opioid injections reduced by half (Adjusted Incidence Rate Ratio = 0.41; 95 % Confidence Interval = 0.25, 0.70; p < 0.01). The number of days smoking fentanyl was associated with fewer number of injections (X(2) = 11.0; p < 0.01). Qualitative interviews revealed that PWID's motivation for switching from injecting tar heroin to smoking fentanyl was related to difficulties accessing veins. After switching to smoking fentanyl, they noticed many benefits including how the drug felt, improved health, fewer financial constraints, and reduced stigma.
Between 2018 and 2020, there was a shift from injecting tar heroin to smoking fentanyl in San Francisco. Reductions in injection of illicit drugs may offer public health benefit if it reduces risk of blood-borne viruses, abscesses and soft-tissue infections, and infective endocarditis.
在美国，非法制造的芬太尼的引入逐渐取代了海洛因。新的非法药物通常与给药频率和方式的变化有关。我们评估了在旧金山芬太尼供应新时代，注射频率和吸食芬太尼的变化。
我们使用靶向抽样方法，于 2018 年至 2020 年在旧金山招募了 395 名注射吸毒者（PWID）参与观察性队列研究。我们在四个六个月期间评估了注射频率、阿片类药物注射频率和芬太尼吸食频率的变化。我们还对 PWID 进行了定性访谈，询问他们注射和吸食阿片类药物的动机。
过去一个月的注射次数中位数在半年度日历年内稳步下降，从 2018 年 7 月至 12 月的 92 次降至 2020 年 1 月至 6 月的 17 次。阿片类药物注射次数减少了一半（调整发病率比 = 0.41；95%置信区间 = 0.25，0.70；p < 0.01）。吸食芬太尼的天数与注射次数减少相关（X² = 11.0；p < 0.01）。定性访谈显示，PWID 从注射海洛因转为吸食芬太尼的动机与静脉穿刺困难有关。转为吸食芬太尼后，他们注意到许多好处，包括药物的感觉、改善健康、减少经济限制和减少耻辱感。
2018 年至 2020 年期间，旧金山从注射海洛因转为吸食芬太尼的情况有所转变。减少非法药物的注射可能会带来公共卫生益处，因为这可能降低血液传播病毒、脓肿和软组织感染以及感染性心内膜炎的风险。
