Assessing First Responders and People Who Use Drugs’ Perceptions of Fentanyl and Drug Checking Services

Abstract

Background: The current wave of the opioid epidemic is primarily driven by the proliferation of fentanyl and its analogs. Fentanyl adulteration, the presence of fentanyl in addition to an expected substance, amplifies the dangers of an opioid overdose for people who use drugs (PWUD). Drug checking services (DCS) are a harm reduction strategy that allows PWUD to chemically analyze the contents of their substances for fentanyl adulteration to make informed decisions regarding their drug use and prevent fentanyl-involved overdoses. This study assessed PWUDs’ perceptions of fentanyl and DCS and first responders' perceptions of fentanyl and safer use supplies (SUS), which include DCS. Methods: The risk environment framework informed the qualitative study. First responders and PWUD, were recruited using a convenience sampling approach from first responder agencies and three community service locations in King County, Washington respectively. Semi-structured interviews were conducted with first responders (n=32) and PWUD (n=13) until data saturation. The qualitative data from the interviews were analyzed using a hybrid deductive and inductive thematic analysis approach by two investigators from the Research with Expert Advisors on Drug Use (READU) team, composed of people with lived and living experiences of drug use. Themes were generated, iteratively refined, and reviewed by the READU team. Results: Thematic analysis revealed first responders’ perceptions of the impacts of fentanyl adulteration on the volume and nature of first responders' responses to overdose events and the drug use landscape. PWUDs’ views of fentanyl varied on a continuum, where some reported fentanyl as a drug of choice, a willingness to use fentanyl-adulterated substances, and others expressed their aversion to fentanyl. The saturation of the drug supply with fentanyl altered PWUDs’ use, experiences with using substances, and overdose risk. First responders’ perceptions of SUS were mixed with some first responders believing that their distribution of SUS would be feasible, provide safer options, and reduce PWUDs’ overdose risk through harm reduction. Other first responders were concerned that it was beyond their scope of duty and that it would enable and perpetuate a cycle of harm. PWUDs’ support for DCS was low with some PWUDs expressing the belief that DCS was useful as it provided information on the contents of their substances, addressed their safety concerns, and promoted safer use behaviors. In contrast, some participants believed that the results of DCS would not influence drug use behaviors or be useful as fentanyl adulteration was not a personal concern. Barriers to using DCS may be addressed by increasing access and improving the utility and usability of DCS. Conclusions: Despite its benefits, DCS may only be feasible and useful for a subset of PWUD, specifically for PWUD who do not use fentanyl and are concerned with fentanyl adulteration. The results of the study provide timely information on the drug use landscape and offer recommendations for the implementation of DCS in King County, to increase harm reduction options for PWUD. Future research should further evaluate the implementation of interventions involving DCS and its efficacy in preventing overdoses and overdose deaths.