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首页> 外文期刊>The International journal of drug policy >Consumer discernment of fentanyl in illicit opioids confirmed by fentanyl test strips: Lessons from a syringe services program in North Carolina
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Consumer discernment of fentanyl in illicit opioids confirmed by fentanyl test strips: Lessons from a syringe services program in North Carolina

机译：Fentanyl测试条的非法阿片类药物的消费者辨别芬太尼：北卡罗来纳州注射器服务计划的课程

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Background: The United States (U.S.) continues to witness an unprecedented increase in opioid overdose deaths driven by precipitous growth in the supply and use of illicitly-manufactured fentanyls (IMF). Fentanyl's growing market share of the illicit opioid supply in the U.S. has led to seismic shifts in the composition of the country's heroin supply. The growth in fentanyl supply has transformed illicit opioid markets once offering heroin with fairly consistent purity and potency to a supply overpopulated with fentanyl(s) of inconsistent and unpredictable potency. In response, people who inject drugs (PWID) have developed a number of sensory strategies to detect fentanyl in illicit opioids. The current study examined the accuracy of sensory discernment strategies by measuring study participants' descriptions of the last opioid injected and checked with a fentanyl test strip (FTS) by that test's positive/negative result. The primary objective was to determine associations between FTS results and descriptions of the illicit opioid's physical appearance and physiological effects. Methods: Between September-October 2017, a total of 129 PWID were recruited from a syringe services program in Greensboro, North Carolina and completed an online survey about their most recent use of FTS. Participants were instructed to describe the appearance and effects associated with the most recent opioid they injected and tested with FTS. We conducted bivariate and multivariate analyses to determine differences in positive vs negative FTS results and the physical characteristics and physiological experiences reported. An exploratory analysis was also conducted to describe the types and bodily locations of unusual sensations experienced by PWID reporting positive FTS results. Results: For physical characteristics, 32% reported that the drug was white before adding water and 38% reported the solution was clear after adding water. For physiological effects compared to heroin, 42% reported a stronger rush, 30% a shorter high, 30% a shorter time to the onset of withdrawal symptoms, and 42% experienced unusual sensations. In the multivariable model adjusting for demographics and polydrug correlates, white color of drug before adding water, stronger rush, shorter time to withdrawal, and unusual sensations were significantly associ-ated with a positive FTS result. The most common unusual sensations were pins and needles (51%), warming of the head and face (35%), and lightheadedness (30%), and the most common locations where sensations occurred were face and neck (61%), arms/legs (54%), and chest (37%). Conclusion: We found positive FTS results were significantly associated with the physical characteristics and physiological effects described by PWID. Descriptions concerning physical appearance were consistent with law enforcement profiles of illicitly-manufactured fentanyl and physiological effects were concomitant with scientific and clinical medical literature on iatrogenic fentanyl use. Taken together, these findings suggest sensory strate-gies for detecting fentanyl in illicit opioids may be an effective risk reduction tool to help consumers navigate unpredictable markets more safely.
机译：背景：由于非法制造的芬太尼（IMF）的供应和使用急剧增加，美国（U.S.）的类阿片过量死亡人数继续出现前所未有的增长。芬太尼在美国非法阿片类药物供应中的市场份额不断增长，导致该国海洛因供应的构成发生了巨大变化。芬太尼供应的增长已经将曾经提供纯度和效力相当一致的海洛因的非法类阿片市场转变为芬太尼供应过多、效力不一致和不可预测的市场。作为回应，注射毒品者（PWID）开发了许多感官策略来检测非法阿片类药物中的芬太尼。目前的研究通过测量研究参与者对最后一次注射的阿片类药物的描述，并通过芬太尼试纸（FTS）检查该测试的阳性/阴性结果，来检验感官辨别策略的准确性。主要目的是确定FTS结果与非法阿片类物质的物理外观和生理效应描述之间的关联。方法：2017年9月至10月期间，共有129名PWID从北卡罗来纳州格林斯伯勒的一个注射器服务项目中招募，并完成了一项关于他们最近使用FTS的在线调查。受试者被要求描述他们最近注射并用FTS测试的阿片类药物的外观和效果。我们进行了双变量和多变量分析，以确定阳性和阴性FTS结果的差异，以及报告的身体特征和生理经验。还进行了探索性分析，以描述PWID报告FTS阳性结果时所经历的异常感觉的类型和身体位置。结果：在物理特性方面，32%的人表示加水前药物呈白色，38%的人表示加水后溶液呈澄清状态。与海洛因相比，在生理效应方面，42%的人报告了更强的冲动，30%的人报告了更短的高潮，30%的人报告了更短的时间出现戒断症状，42%的人经历了不寻常的感觉。在对人口统计学和多种药物相关性进行调整的多变量模型中，加水前药物的白色、更强烈的冲刺、更短的停药时间和异常感觉与FTS阳性结果显著相关。最常见的异常感觉是针和针（51%）、头部和面部发热（35%）和头晕（30%），最常见的感觉部位是面部和颈部（61%）、手臂/腿（54%）和胸部（37%）。结论：我们发现FTS阳性结果与PWID描述的生理特征和生理效应显著相关。关于物理外观的描述与非法生产芬太尼的执法概况一致，生理效应与关于医源性芬太尼使用的科学和临床医学文献一致。综上所述，这些发现表明，检测非法阿片类药物中芬太尼的感官策略可能是一种有效的风险降低工具，可以帮助消费者更安全地在不可预测的市场中导航。

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