According to recent research conducted by the NYU School of Global Public Health, a significant majority of individuals in New York City who inject drugs are testing positive for the opioid fentanyl, despite only a small percentage intentionally using it. The study, published in the International Journal of Drug Policy, highlights the possibility of widespread unknowing usage of fentanyl among drug users, which can increase the risks of overdose. As drug overdose cases continue to rise in New York City, primarily due to the growing presence of fentanyl, the study’s lead author emphasizes the importance of monitoring exposure rates, changes in user preference, and implementing innovative strategies to reduce overdoses, including increased support for overdose prevention centers and further research.
The study reveals that over 80% of individuals in New York City who use injectable drugs have tested positive for fentanyl, even though only 18% of them reported intentional usage. This suggests that a significant number of drug users might unknowingly be consuming fentanyl, thereby increasing the chances of overdosing and potentially developing tolerance to fentanyl over time if continued use persists.
In the United States, more than 100,000 people died from drug overdoses in 2021, with illicit fentanyl being involved in 66% of these deaths. In New York City, drug overdose deaths have tripled since 2013 when fentanyl started appearing regularly in the illegal drug market. Since 2017, fentanyl has become the most common drug associated with overdose deaths in the city.
Research indicates that individuals who use drugs may unintentionally use fentanyl, mistakenly thinking they are consuming heroin or another substance. However, recent studies show that some individuals are aware of their fentanyl use and may actively seek out fentanyl or heroin mixed with fentanyl.
Courtney McKnight, the lead author of the study and a clinical assistant professor of epidemiology at NYU School of Global Public Health, highlights the importance of monitoring fentanyl exposure rates and changes in user preferences among drug users. McKnight stresses the need to address the issue by increasing awareness and implementing effective prevention strategies.
To gain insights into the prevalence of fentanyl use in New York City, McKnight and her colleagues conducted surveys and interviews in 2021 and 2022 with individuals who inject drugs. Participants were asked about their drug use, including intentional fentanyl usage in the past month, as well as their experiences with overdoses. The researchers compared the participants’ self-reported drug use with the results of toxicology tests for fentanyl, heroin, other opioids, and stimulants.
The toxicology results revealed widespread fentanyl use among intravenous drug users in New York City. Fentanyl was the most commonly used drug, with 83% of participants testing positive for it. Of these, 46% tested positive for both fentanyl and heroin, while 54% tested positive for fentanyl alone. However, only 18% reported intentionally using fentanyl recently, with most preferring heroin instead.
McKnight states, “The majority of individuals in this study, regardless of their intentional fentanyl use, reported heroin as their primary drug, indicating a strong preference for heroin over fentanyl. Nevertheless, our urine toxicology data suggest that people who inject drugs have limited control over avoiding fentanyl.”
The study also found that nearly one-quarter of participants had experienced at least one overdose in the previous six months. Among those who intentionally used fentanyl, 36% had recently overdosed, compared to 21% of those who tested positive for fentanyl but reported no recent usage, and 19% who tested negative for fentanyl and reported no recent usage. Intentional fentanyl users were also more likely to be younger, white, frequent drug users, and test positive for stimulants, among other characteristics.
Concerns about overdosing were prevalent among the participants, and many reported using various strategies to prevent overdoses, such as having naloxone (a drug that can reverse opioid overdoses) nearby, using smaller drug amounts, using drugs in the presence of others, and relying on trusted dealers.
The interviews conducted during the study revealed that individuals who inject drugs may be developing an increased tolerance to fentanyl, leading to a greater preference for this more potent drug. Several interviewees mentioned a decline in the potency of heroin, indicating a potential unintended tolerance to fentanyl that heroin can no longer address.
The researchers emphasize the necessity of scaling up evidence-based methods to prevent overdose deaths, including increasing access to naloxone and medication for opioid use disorder. However, due to the prevalence and lethality of fentanyl, they suggest considering novel strategies to reduce overdoses, such as providing increased support for overdose prevention centers and exploring other forms of opioid maintenance treatments where individuals who use drugs are prescribed opioids to avoid fentanyl-contaminated substances.
McKnight states, “New York City is home to the country’s first two legally sanctioned overdose prevention centers, which opened in 2021 and have already saved hundreds of lives. However, further support and access to these programs are required to further reduce overdose mortality.”
The study received funding from the National Institute on Drug Abuse and involved additional authors from NYU School of Global Public Health, including Allen Weng, Marley Reynoso, Sarah Kimball, Lily M. Thompson, and Don Des Jarlais.
Frequently Asked Questions (FAQs) about overdose prevention strategies
What does the research reveal about fentanyl usage among intravenous drug users in New York City?
The research reveals that over 80% of individuals in New York City who inject drugs have tested positive for fentanyl, even though only 18% of them reported intentional usage. This suggests widespread unintentional fentanyl usage among drug users.
Why is unintentional fentanyl usage concerning?
Unintentional fentanyl usage raises the risks of overdose among drug users. Fentanyl is a potent opioid, and individuals unknowingly consuming it may not be aware of its strength, leading to a higher likelihood of overdose and potential tolerance development over time.
How has fentanyl impacted drug overdose deaths in New York City?
Since fentanyl’s increased presence in the illicit drug supply starting in 2013, drug overdose deaths in New York City have more than tripled. Fentanyl has become the most common drug involved in overdose deaths since 2017, contributing significantly to the opioid crisis in the city.
What strategies are recommended to reduce overdose risks associated with fentanyl usage?
The study highlights the importance of monitoring fentanyl exposure rates and changes in user preferences. To reduce overdose risks, implementing novel strategies such as increasing support for overdose prevention centers, expanding access to naloxone, and exploring opioid maintenance treatments are suggested. These strategies aim to provide comprehensive prevention and harm reduction measures for individuals using drugs.
What are the implications of the study’s findings?
The study’s findings emphasize the urgent need to address unintentional fentanyl usage among drug users in New York City. By implementing evidence-based prevention methods and conducting further research, it is possible to mitigate overdose risks and improve the overall health outcomes of individuals struggling with substance abuse.
More about overdose prevention strategies
- International Journal of Drug Policy: Understanding intentionality of fentanyl use and drug overdose risk
- NYU School of Global Public Health: Research on Drug Use and Overdose Prevention
- National Institute on Drug Abuse: Opioid Overdose Crisis
- NYC Health: Overdose Prevention Centers
- Substance Abuse and Mental Health Services Administration (SAMHSA): Naloxone
- Centers for Disease Control and Prevention (CDC): Opioid Overdose
