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      Heroin uncertainties: exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’

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          Abstract

          Background

          The US is experiencing an unprecedented opioid overdose epidemic fostered in recent years by regional contamination of the heroin supply with the fentanyl family of synthetic opioids. Since 2011 opioid-related overdose deaths in the East Coast state of Massachusetts have more than tripled, with 75% of the 1374 deaths with an available toxicology positive for fentanyl. Fentanyl is 30–50× more potent than heroin and its presence makes heroin use more unpredictable. A rapid ethnographic assessment was undertaken to understand the perceptions and experiences of people who inject drugs sold as ‘heroin’ and to observe the drugs and their use.

          Methods

          A team of ethnographers conducted research in northeast Massachusetts and Nashua, New Hampshire in June 2016, performing (n=38) qualitative interviews with persons who use heroin.

          Results

          1) The composition and appearance of heroin changed in the last four years; 2) heroin is cheaper and more widely available than before; and 3) heroin ‘types’ have proliferated with several products being sold as ‘heroin’. These consisted of two types of heroin (alone), fentanyl (alone), and heroin-fentanyl combinations. In the absence of available toxicological information on retail-level heroin, our research noted a hierarchy of fentanyl discernment methods, with embodied effects considered most reliable in determining fentanyl’s presence, followed by taste, solution appearance and powder color. This paper presents a new ‘heroin’ typology based on users’ reports.

          Conclusion

          Massachusetts’ heroin has new appearances and is widely adulterated by fentanyl. Persons who use heroin are trying to discern the substances sold as heroin and their preferences for each form vary. The heroin typology presented is inexact but can be validated by correlating users’ discernment with drug toxicological testing. If validated, this typology would be a valuable harm reduction tool. Further research on adaptations to heroin adulteration could reduce risks of using heroin and synthetic opioid combinations.

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          Author and article information

          Journal
          9014759
          21498
          Int J Drug Policy
          Int. J. Drug Policy
          The International journal on drug policy
          0955-3959
          1873-4758
          3 August 2017
          18 July 2017
          August 2017
          01 August 2018
          : 46
          : 146-155
          Affiliations
          [1 ]Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Ave., MU-3E, Box 900, San Francisco, CA 94143-0900
          Author notes
          [* ] Send correspondence to: Daniel Ciccarone, MD, MPH, Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Ave., MU-3E, Box 900, San Francisco, CA 94143-0900, T: 415-514-0275, daniel.ciccarone@ 123456ucsf.edu
          Article
          PMC5577861 PMC5577861 5577861 nihpa892303
          10.1016/j.drugpo.2017.06.004
          5577861
          28735775
          d7fcd09c-46e3-4976-b18e-41c5a1d85799
          History
          Categories
          Article

          heroin,fentanyl,opiates,overdose,mortality,qualitative research
          heroin, fentanyl, opiates, overdose, mortality, qualitative research

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