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芬太尼污染冰毒的态度和经验:在使用冰毒和其他药物的人群中探索自我报告和尿液毒理学。

Attitudes and experiences with fentanyl contamination of methamphetamine: exploring self-reports and urine toxicology among persons who use methamphetamine and other drugs.

机构信息

College of Health Solutions, Arizona State University, 425 N 5Th Street, ABC 121, Phoenix, AZ, 85004, USA.

Montgomery County Coroner's Office and Crime Laboratory, Dayton, OH, USA.

出版信息

Harm Reduct J. 2023 Apr 20;20(1):54. doi: 10.1186/s12954-023-00782-1.

Abstract

BACKGROUND

There are growing concerns about illicitly manufactured fentanyl (IMF) contamination of methamphetamine. This study aims to characterize the lay views and experiences with IMF-contaminated methamphetamine (IMF/meth) and identify participants with unknown IMF exposures through urine toxicology analysis.

METHODS

Between December-2019 and November-2021, structured interviews were conducted with 91 individuals who reported past 30-day use of methamphetamine and resided in Dayton, Ohio, USA. Lab-based urine toxicology analyses were conducted to identify fentanyl/analogs, methamphetamine, and other drugs. Bivariate analyses were conducted to identify characteristics associated with attitudes and experiences with IMF/meth, and unknown IMF exposures.

RESULTS

The majority (95.6%) of the study participants were non-Hispanic white, and 52.7% were female. Past 30-day use of methamphetamine was reported on a mean of 18.7 (SD 9.1) days, and 62.6% also reported past 30-day use of heroin/IMF. Most (76.9%) had a history of an unintentional drug-related overdose, but 38.5% rated their current risk for an opioid overdose as none. Besides fentanyl (71.9%), toxicology analysis identified nine fentanyl analogs/metabolites (e.g., 42.7% acetyl fentanyl, 19.0% fluorofentanyl, 5.6% carfentanil), and 12.4% tested positive for Xylazine. The majority (71.4%) believed that IMF/meth was common, and 59.3% reported prior exposures to IMF/meth. 11.2% tested positive for IMF but reported no past 30-day heroin/IMF use (unknown exposure to IMF). Views that IMF/meth was common showed association with homelessness (p = 0.04), prior overdose (p = 0.028), and greater perceived risk of opioid overdose (p = 0.019). Self-reported exposure to IMF/meth was associated with homelessness (p = 0.007) and obtaining take-home naloxone (p = 0.025). Individuals with unknown IMF exposure (test positive for IMF, no reported past 30-day heroin/IMF use) were older (49.9 vs. 41.1 years, p < 0.01), and reported more frequent past 30-day use of methamphetamine (24.4 vs. 18.0 days, p < 0.05). They indicated lower perceived risk of opioid overdose (0.1 vs. 1.9, scale from 0 = "none" to 4 = "high," p < 0.001).

DISCUSSION

This study suggests a need for targeted interventions for people who use methamphetamine and expansion of drug checking and other harm reduction services.

摘要

背景

人们对非法制造的芬太尼(IMF)污染甲基苯丙胺(IMF/meth)的情况越来越担忧。本研究旨在描述与 IMF/meth 相关的认知和经验,并通过尿液毒理学分析确定有未知 IMF 暴露的参与者。

方法

2019 年 12 月至 2021 年 11 月,对 91 名报告过去 30 天内使用过甲基苯丙胺且居住在美国俄亥俄州代顿市的个人进行了结构化访谈。通过实验室尿液毒理学分析,以鉴定芬太尼/类似物、甲基苯丙胺和其他药物。进行了双变量分析,以确定与对 IMF/meth 的态度和经验以及未知 IMF 暴露相关的特征。

结果

研究参与者中大多数(95.6%)是非西班牙裔白人,52.7%为女性。过去 30 天内,甲基苯丙胺的使用天数平均为 18.7(SD 9.1)天,62.6%还报告过去 30 天内使用过海洛因/IMF。大多数(76.9%)有过非故意的药物相关药物过量史,但 38.5%认为目前阿片类药物过量的风险为零。除了芬太尼(71.9%),毒理学分析还发现了 9 种芬太尼类似物/代谢物(例如,42.7%乙酰芬太尼,19.0%氟芬太尼,5.6%卡芬太尼),12.4%检测到 Xylazine。大多数(71.4%)认为 IMF/meth 很常见,59.3%报告曾接触过 IMF/meth。11.2%检测到 IMF,但报告过去 30 天内没有使用过海洛因/IMF(未知 IMF 暴露)。认为 IMF/meth 很常见的观点与无家可归(p=0.04)、既往药物过量(p=0.028)和更高的阿片类药物过量风险感知(p=0.019)有关。自我报告的 IMF/meth 暴露与无家可归(p=0.007)和获得带回家的纳洛酮(p=0.025)有关。有未知 IMF 暴露(检测到 IMF,但无报告过去 30 天内使用过海洛因/IMF)的个体年龄较大(49.9 岁比 41.1 岁,p<0.01),且过去 30 天内使用甲基苯丙胺的频率更高(24.4 天比 18.0 天,p<0.05)。他们表示阿片类药物过量的风险感知较低(0.1 比 1.9,范围从 0 表示“无”到 4 表示“高”,p<0.001)。

讨论

本研究表明,需要针对使用甲基苯丙胺的人群进行有针对性的干预,并扩大药物检测和其他减少伤害的服务。

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