Experiences with and attitudes towards fentanyl and fentanyl-contaminated drugs: A qualitative study of people receiving medications for opioid use disorder in a unified prison and jail system


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    <p>ID: HR19-129</p>

    <p><i>Presenting author:</i>
                                    Alexandria Macmadu                        </p>

    <h4 class="My(0)">Presenting author biography:</h4>
            Alexandria Macmadu, MSc is a doctoral student in the Department of Epidemiology at the Brown University School of Public Health. She is also a Research Project Director at the Center for Prisoner Health and Human Rights. Both institutions are located in Providence, Rhode Island, USA.    
    <h1 class="Fz(1.3rem)">Experiences with and attitudes towards fentanyl and fentanyl-contaminated drugs: A qualitative study of people receiving medications for opioid use disorder in a unified prison and jail system</h1>

    <p>Alexandria Macmadu, Josiah Rich, Meghan Peterson, Kimberly Pognon, Brandon Marshall, Traci Green, Rosemarie Martin, Lauren Brinkley-Rubinstein</p>

    <p>Background: The dramatically increasing prevalence of illicit fentanyl and fentanyl-contaminated drugs (FCDs) presents dire risks for people who use drugs (PWUD) in many areas of the world. Among PWUD, people who experience incarceration represent a high-risk subpopulation for fentanyl-related overdose post-release. The current study explored experiences with and attitudes towards fentanyl and FCDs among people receiving medications for opioid use disorder (MOUD) in a unified prison and jail system.</p><p>Methods: Between June and August of 2018, in-depth interviews were conducted with 40 individuals receiving MOUD at the Rhode Island Department of Corrections in the US. Domains explored included treatment and drug use experiences, including perspectives on fentanyl and FCDs. Interview transcripts were coded and analyzed using a general inductive approach.</p><p>Results: The median age of participants was 36, 28 (70%) were male, and 33 (83%) were white. Most participants reported that fentanyl and FCDs were pervasive throughout the local drug supply. Among those with suspected exposure to fentanyl and FCDs, most reported that the drugs’ effects were unfavorable. As compared to heroin, the short duration and strong intensity of fentanyl and FCDs—as well as their known overdose risk—were commonly cited as negative attributes. Some participants reported being able to identify fentanyl and FCDs prior to ingestion by differences in taste, smell, and appearance. Protective measures adopted for increased safety and/or avoidance of fentanyl and FCDs included using with others, taking a test dose, using fentanyl test kits, and purchasing drugs from a consistent and trusted source.</p><p>Conclusions: Given the rise in fentanyl-related fatalities, harm reduction programs that address the unique challenges and risks associated with fentanyl and FCDs are urgently needed. These initiatives should target people who are incarcerated and other high risk populations. Expanded provision of MOUD in prison and jail settings is also critically needed.</p>
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