Opioid drug abusers try to avoid fentanyl because of its extreme potency but the drug is now causing the majority of the overdose deaths in Rhode Island, according to two recent studies by researchers at Brown University, and a similar pattern may be emerging elsewhere in the country.
“Most people are not asking for it,” said Jennifer Carroll, lead author of one of the studies and an adjunct assistant professor of medicine at the Warren Alpert Medical School of Brown University. “They can’t avoid it, and their desire to avoid it is not reducing their risk.”
The studies underscore the urgency of combating the misuse of fentanyl and undermine a common perception that many users court the drug for its potency.
The number of overdose deaths in Rhode Island attributable to fentanyl rose to 138 in the first nine months of 2016, compared to 84 in all of 2014, according to a study led by Brandon Marshall, an assistant professor of epidemiology at the Brown University School of Public Health. In 2014, 35 percent of the state’s fatal overdoses occurred because of fentanyl, but it was involved in 56 percent of drug deaths by 2016.
Moreover, mapping all 778 overdose deaths in the state during the study period showed that fentanyl-related deaths occur virtually everywhere that heroin overdoses are occurring. Fentanyl, is is often used to lace heroin but many users can’t tell if it is present.
“We were surprised that we saw such similar geographic patterns,” Marshall said. “What we’re drawing from that is that there is widespread contamination of the drug supply with fentanyl. It’s not clustered in one city or town.”
The data do show ominous differences with fatal fentanyl overdoses. One is is that they are particularly likely among users who inject drugs. Another is that users are now dying younger. Marshall said his hypothesis is that with fentanyl in the mix, the lifetime risk of a deadly drug overdose accumulates much faster than it used to.
In surveys of 149 users and face-to-face interviews with 47 of them, Carroll’s team found a palpable fear and dislike for fentanyl among drug users. Four in five respondents said they were well aware of fentanyl and its dangers, but many described difficulty in avoiding it.
Throughout the study, Carroll and her co-authors included direct quotes from user interviews that illustrated the broader trends in the data. Matt, a man in his 20s from western Rhode Island spoke of his fear of fentanyl.
“I’ve seen people OD in front of me from shooting the stuff,” he is quoted as saying. “People are dropping like flies. I’ve had three friends I grew up with since I was 10. They’re all dead from [heroin cut with fentanyl].”
Another user, Jason, said that if he is struggling enough with the onset of withdrawal symptoms, he’ll still use heroin even if he suspects the presence of fentanyl. So he’ll try a little first to see if he feels fentanyl’s very strong effects.
“[It depends on] the availability of other batches and how sick I am,” he said. “If I’m sick, I gotta do it, you know? I won’t do half a gram. You know, I’ll do a little pinch and I’ll figure it out from there, but I won’t start big. It’s scary. I’ve watched overdoses. And I’ve had one in front of my girl.”