Experiences with fentanyl and tranquilizer use, overdose, and harm reduction behaviors in participants from a Philadelphia, PA (USA) harm reduction organization.

Author: Amy Jessop, Madison Scialanca, Patrick Kelly, Ariel Hoadley, Katie Singley, Rachel Holbert, Sarah Bass

Theme: Epidemiology & Public Health Research Year: 2023

In Philadelphia, PA, once deemed the “heroin capital” of the US, fentanyl is omnipresent. Use of fentanyl and additives like xylazine (referred to as “tranq”) has altered substance use practices and health risks. Regular assessment of drug use practices is essential to adapt harm reduction efforts to meet community needs and reduce substance use related morbidity and mortality. .

Between October 2021 and September 2022, we surveyed 100 participants at Prevention Point Philadelphia (PPP), a U.S. based multiservice harm reduction organization, about experiences with using fentanyl and tranq, overdose, and overdose prevention actions. The group was 57% male, 37% non-White, mean age 40 years, and 84% were temporarily housed or unhoused. We employed descriptive and non-parametric methods to describe responses and compare subgroups.

Fentanyl use is ubiquitous (98% used or suspect used) and two-thirds believed >80% of street drugs contain fentanyl. Most (75%) reported tranq use. A majority believed tranq extends or enhances fentanyl’s effects and increases risk of overdose and wounds. Overdose experiences were common – 34% reported overdosing, 92% witnessed an overdose (54% witnessed >30), 76% have administered naloxone, 61% were quite or very worried they will overdose, and 55% carry naloxone all the time. However, only 39% reported using fentanyl test strips. Almost half had history of previous substance use treatment. Significant differences in overdose concerns and prevention actions by age, gender and overdose history were found.

Overdose is frequent and participants carry and use naloxone, highlighting the need for continued or expanded distribution. Tranq use is common and desired; a better understanding of tranq’s role in substance use behaviors and health risks is needed. Engaging and learning from those who have adopted overdose prevention actions could lead to more effective policies and programs to reduce morbidity and mortality from substance use.

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