“I Use Because I'm in Pain”: Perspectives on Harm Reduction Services and Unmet Needs Among People Who Use Fentanyl

Abstract

BackgroundDespite King County pledging over $10 million to harm reduction measures in 2021, overdose deaths in the area have steadily risen with increasing rates predominantly caused by an increase in use of illicit fentanyl, a synthetic opioid much stronger than heroin. Previous studies have shown significant access barriers to harm reduction interventions commonly administered to people who use fentanyl. Our research sought to interview people who use fentanyl in King County to assess their interactions with harm reduction interventions, including barriers to engagement and needs not currently met.

Methods In partnership with an organization that provides homelessness and substance use services, people who used fentanyl were recruited for semi-structured interviews. Demographic information, including modalities of substance use, was attained during the interviews. Interviews were conducted until thematic saturation was reached. They were recorded, transcribed, and then individually coded for themes using a thematic inductive framework.

Results Fifteen participants (mean age 46.6 years) completed interviews. All participants used fentanyl pills with some combination of fentanyl powder, heroin, methamphetamines, and crack cocaine. Themes were divided into two main categories: unmet needs (housing, pain management, isolation/community engagement, and case worker communication), and perspectives on harm reduction interventions (Suboxone, methadone, overdose prevention medication and fentanyl testing strips). Specific perspectives and barriers were explored in subthemes. DiscussionFindings are reviewed in light of previous research and the current opioid treatment plan for King County. All unmet needs connected directly to participants’ difficulty meeting substance use goals, suggesting that housing, pain management, and community engagement interventions may be necessary measures within harm reduction frameworks. Physical barriers with Suboxone, access issues with methadone, and administrative issues with naloxone were the largest identified harm reduction intervention barriers, all affirmed by previous research. Contrary to previous research, there were no significant use issues identified with fentanyl testing strips, though general engagement was low, suggesting that education and outreach may be key to increasing testing strip usage.