Two new studies look at how intravenous drug users can lessen risk of overdose

The abuse of fentanyl, a synthetic opioid 100 times more potent than morphine and used to treat severe pain, has been a growing public health issue in the United States. The National Institute on Drug Abuse reports that 128 people died each day in the U.S. in 2018 from opioid overdoses, many involving fentanyl.

Much of the public health research that’s been done on opioid overdoses focuses on emergency treatment options, including naloxone, a drug used to treat opioid overdoses.

However, two recent studies from UC Berkeley School of Public Health, UCSF, and the City and County of San Francisco researchers take a different perspective, looking at how drug users can lessen their own risk of overdose. One study researched how fentanyl test strips—used by addicts to avoid street drugs laced with the potentially deadly drug—changed drug use in the city and county of San Francisco; the other study looked at the rate of drug users who took opioid overdose response training in the same city.

Both papers were published by the same group of researchers in the International Journal of Drug Policy.

“Personally, my motivations for the study began at UC Berkeley,” said Hayoung Oh, an author on both papers and a Berkeley Public Health student studying global health epidemiology. “As a student, it was jarring to study at a prestigious elite university while living in a city where homelessness continues to be a serious issue.”

Fentanyl test strips can be used by drug users to identify fentanyl-laced drugs, which can then be avoided, preventing overdoses. Researchers found that in 12 months prior to their study, more than 45% of a group of 458 individuals who inject drugs had used fentanyl test strips. The use of fentanyl test strips was much higher among those who had witnessed an overdose in the past, who possessed naloxone (available from treatment centers and pharmacies), and who were younger in age.

Although the study did not ask respondents where they received the fentanyl test strips, the strips are available at treatment centers, homeless clinics, and harm reduction clinics.

The researchers found that more than 80% of fentanyl test strip users had seen positive results when testing injectable drugs, but that more than 43% still injected the tainted product. About 26% abstained from using the tainted drugs and over 30% chose to inject a lower dosage.

“This was a preliminary study to know more about what we do not know. For example, there are age differences that exist in the data. We don’t understand why, however. Similarly, we noted racial differences, with Black people being less likely to use fentanyl test strips. Careful future studies are needed to understand this relationship,” Oh said. “When someone receives a positive fentanyl test strip result and makes no change in their dosage, is it because they wanted fentanyl in the drug or because there was no other option?”

The fentanyl test strip study showed that those who had previous opioid overdose response training were more likely to use the fentanyl test strips. In the second study, the same group of researchers measured the rates of opioid overdose response training within the same group of 458 intravenous drug users.

This study found that more than 76% of respondents primarily used opioids and about 63% had received opioid overdose response training. More than 68% owned a naloxone kit. Researchers found that almost 78% had witnessed an overdose in the past, and among that group, more than half had administered naloxone the last time they witnessed an overdose.

Researchers of the study were motivated to find out what percentage of those who inject drugs were trained in overdose response and where any disparities may exist within that population.

Researchers found a large discrepancy between the rates of opioid overdose response training for white people and people of color who were surveyed. Almost 70% of White respondents had training, while only 50% of Black respondents had similar training.

“Through our study, we hope that we can close the gaps through outreach to target populations, particularly non-White communities, and continue advocating for the saturation of naloxone supply to further reduce overdose mortality in San Francisco,” Kyu Min Kim, another author on both studies and a recent UC Berkeley graduate, said.

“The US is in the midst of an unprecedented opioid epidemic. How we respond from a public health community standpoint can drastically lessen the number of lives at risk,” Oh said. “These studies offer a baseline understanding of the current situation in San Francisco, but future studies need to build off of these to identify the specific needs of the community.”