Little is currently known about nonmedical fentanyl use (NFU; that is, use of illicit or pharmaceutically produced fentanyl without a prescription or in ways other than prescribed) despite increases in prevalence and consequences (e.g., overdose, fatality). Individuals with a lifetime history of NFU (N = 122) in the United States completed an online survey assessing demographics and factors related to use. Results revealed diversion of prescriptions, unintentional use of illicit fentanyl, and high co-occurrence of mental illness and other illicit substance use among users. Commonly reported motives reflected negative/positive reinforcement (e.g., to relieve stress, to get high) and relieving pain/physical discomfort, regardless of frequency of use. More severe consequences (e.g., increased tolerance, withdrawal) were reported among high frequency users. This descriptive examination of NFU may aid in the identification of individuals at-risk for use, promote an understanding of reasons for use, and guide prevention and intervention developments.
AlessiE. J.MartinJ. I. (2010). Conducting an internet-based survey: Benefits, pitfalls, and lessons learned. Social Work Research, 34, 122-128.
2.
AllanJ.HerridgeN.GriffithsP.FisherA.ClarkeI.CampbellM. (2015). Illicit fentanyl use in rural Australia: An exploratory study. Journal of Alcoholism & Drug Dependence, 3, 2-7.
3.
CarrollJ. J.MarshallB. D.RichJ. D.GreenT. C. (2017). Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study. International Journal of Drug Policy, 46, 136-145.
4.
Centers for Disease Control and Prevention. (2015). Health advisory: Increases in fentanyl drug confiscations and fentanyl-related overdose fatalities. Atlanta, GA: US Department of Health and Human Services. Retrieved from: https://emergency.cdc.gov/han/han00384.asp.
5.
ChiauzziE.DasMahapatraP.LoboK.BarrattM. J. (2013). Participatory research with an online drug forum: A survey of user characteristics, information sharing, and harm reduction views. Substance Use & Misuse, 48, 661-670.
6.
CiccaroneD.OndocsinJ.MarsS. G. (2017). Heroin uncertainties: Exploring users’ perceptions of fentanyl-adulterated and-substituted “heroin.”International Journal of Drug Policy, 46, 146-155.
7.
ComptonW. M.VolkowN. D. (2006). Major increases in opioid analgesic abuse in the United States: Concerns and strategies. Drug and Alcohol Dependence, 81, 103-107.
8.
DasguptaN.KramerE. D.ZalmanM. A.CarinoS.SmithM. Y.HaddoxJ. D.WrightC. (2006). Association between non-medical and prescriptive usage of opioids. Drug and Alcohol Dependence, 82, 135-142.
9.
DruckerE.CroftsN. (2017). Are we anywhere near there yet? The state of harm reduction in North America in 2017. Harm Reduction Journal, 14, 55-59.
10.
Drug Enforcement Administration. (2015a). DEA issues nationwide alert on fentanyl as threat to health and public safety. Washington, DC: DEA Public Affairs. Retrieved from: https://www.dea.gov/divisions/hq/2015/hq031815.shtml.
FirestoneM.GoldmanB.FischerB. (2009). Fentanyl use among street drug users in Toronto, Canada: Behavioural dynamics and public health implications. International Journal of Drug Policy, 20, 90-92.
13.
GladdenR. M.MartinezP.SethP. (2016). Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths—27 states, 2013-2014. Morbidity and Mortality Weekly Report, 65, 837-843.
14.
GriswoldM. K.ChaiP. R.KrotulskiA. J.FrisciaM.ChapmanB.BoyerE. W.. . . BabuK. M. (2018). Self-identification of nonpharmaceutical fentanyl exposure following heroin overdose. Clinical Toxicology, 56, 37-42.
15.
HallA. J.LoganJ. E.ToblinR. L.KaplanJ. A.KranerJ. C.BixlerD.. . . PaulozziL. J. (2008). Patterns of abuse among unintentional pharmaceutical overdose fatalities. Journal of the American Medical Association, 300, 2613-2620.
16.
KellyJ. P.CookS. F.KaufmanD. W.AndersonT.RosenbergL.MitchellA. A. (2008). Prevalence and characteristics of opioid use in the US adult population. Pain, 138, 507-513.
17.
LaBarberaM.WolfeT. (1983). Characteristics, attitudes and implications of fentanyl use based on reports from self-identified fentanyl users. Journal of Psychoactive Drugs, 15, 293-301.
18.
MacmaduA.CarrollJ. J.HadlandS. E.GreenT. C.MarshallB. D. (2017). Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically. Addictive Behaviors, 68, 35-38.
19.
ManchikantiL.SinghA. (2008). Therapeutic opioids: A ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician, 11(Suppl. 2), S63-S88.
20.
MarsS. G.BourgoisP.KarandinosG.MonteroF.CiccaroneD. (2014). “Every ‘never’ I ever said came true”: Transitions from opioid pills to heroin injecting. International Journal of Drug Policy, 25, 257-266.
21.
MarshallB. D.KriegerM. S.YedinakJ. L.OgeraP.BanerjeeP.Alexander-ScottN. E.. . . GreenT. C. (2017). Epidemiology of fentanyl-involved drug overdose deaths: A geospatial retrospective study in Rhode Island, USA. International Journal of Drug Policy, 46, 130-135.
22.
MatheiC.ShkedyZ.DenisB.KabaliC.AertsM.MolenberghsG.. . . BuntinxF. (2006). Evidence for a substantial role of sharing of injecting paraphernalia other than syringes/needles to the spread of hepatitis C among injecting drug users. Journal of Viral Hepatitis, 13, 560-570.
23.
McCabeS. E.CranfordJ. A.BoydC. J.TeterC. J. (2007). Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addictive Behaviors, 32, 562-575.
24.
McCabeS. E.TeterC. J.BoydC. J. (2005). Illicit use of prescription pain medication among college students. Drug and Alcohol Dependence, 77, 37-47.
OlsenY.DaumitG. L.FordD. E. (2006). Opioid prescriptions by U.S. primary care physicians from 1992 to 2001. The Journal of Pain, 7, 225-235.
28.
PetersonA. B.GladdenR. M.DelcherC.SpiesE.Garcia-WilliamsA.WangY.. . . GoldbergerB. A. (2016). Increases in fentanyl-related overdose deaths—Florida and Ohio, 2013-2015. Morbidity and Mortality Weekly Report, 65, 844-849.
29.
PortenoyR. K.MessinaJ.XieF.PeppinJ. (2007). Fentanyl buccal tablet (FBT) for relief of breakthrough pain in opioid-treated patients with chronic low back pain: A randomized, placebo-controlled study. Current Medical Research and Opinion, 23, 223-233.
30.
RamoD. E.ProchaskaJ. J. (2012). Broad reach and targeted recruitment using Facebook for an online survey of young adult substance use. Journal of Medical Internet Research, 14(1), e28.
31.
RuddR. A.AleshireN.ZibbellJ. E.Matthew GladdenR. (2016). Increases in drug and opioid overdose deaths—United States, 2000-2014. American Journal of Transplantation, 16, 1323-1327.
32.
SchwartzR. P.GryczynskiJ.O’GradyK. E.SharfsteinJ. M.WarrenG.OlsenY.. . . JaffeJ. H. (2013). Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009. American Journal of Public Health, 103, 917-922.
33.
Substance Abuse and Mental Health Services Administration. (2013). Results from the 2013 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-48, HHS Publication No. SMA 14-4863). Rockville, MD: Author.
34.
Substance Abuse and Mental Health Services Administration (2016). Key substnace use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from: https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.pdf
35.
SuzukiJ.El-HaddadS. (2017). A review: Fentanyl and non-pharmaceutical fentanyls. Drug and Alcohol Dependence, 171, 107-116.
36.
ThorpeL. E.OuelletL. J.HershowR.BaileyS. L.WilliamsI. T.WilliamsonJ.. . . GarfeinR. S. (2002). Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment. American Journal of Epidemiology, 155, 645-653.
37.
UnickJ. G.CiccaroneD. (2017). US regional and demographic differences in the heroin and prescription opioid epidemics. International Journal on Drug Policy, 46, 112-119.
38.
VashishthaD.MittalM. L.WerbD. (2017). The North American opioid epidemic: Current challenges and a call for treatment as prevention. Harm Reduction Journal, 14, Article 7.
39.
VolpeD. A.McMahon TobinG. A.MellonR. D.KatkiA. G.ParkerR. J.ColatskyT.. . . VerboisS. L. (2011). Uniform assessment and ranking of opioid µ receptor binding constants for selected opioid drugs. Regulatory Toxicology and Pharmacology, 59, 385-390.
40.
ZacnyJ. P.Lance LichtorJ.ZaragozaJ. G.de WitH. (1992). Subjective and behavioral responses to intravenous fentanyl in healthy volunteers. Psychopharmacology, 107, 319-332.
