title: Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically.
abstract: The rate of overdose deaths caused by fentanyl-contaminated heroin (FCH) use is increasing rapidly in the United States. We examined risk factors for exposure to FCH and experiences with FCH use among young adult non-medical prescription opioids (NMPO) users.
  
  
  
  We analyzed data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which enrolled young adults aged 18 to 29 reporting prior 30day NMPO use between January 2015 and February 2016. Participants completed questionnaires ascertaining drug use patterns and risk behaviors, including FCH exposure. Logistic regression was used to assess factors associated with known or suspected FCH exposure.
  
  
  
  Of 199 participants, the median age was 25 (IQR: 22, 27), 130 (65.3%) were male, and 122 (61.3%) were of White, non-Hispanic race/ethnicity. In total, 22 (11%) reported known or suspected FCH exposure in the prior six months. Several drug use patterns and risk behaviors were associated with FCH exposure, including: regular heroin and cocaine use; diverted pharmaceutical fentanyl use in the prior six months; NMPO use to avoid withdrawal symptoms; longer duration of NMPO use; regular injection drug use; and prior overdose (all p<0.001). Among participants who reported FCH exposure, 59% were unaware that their heroin was contaminated with fentanyl prior to last use, 59% reported that FCH provides a better high, and all recognized that fentanyl increases overdose risk.
  
  
  
  Exposure to fentanyl-contaminated heroin is an emerging trend among young adult NMPO users in Rhode Island. Overdose prevention programs addressing FCH use are urgently needed.
authors.affiliation: The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI 02906, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S-121-7, Providence, RI 02912, USA.
authors.forename: Alexandria
authors.initials: A
authors.lastname: Macmadu
authors.affiliation: The Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA; Department of Medicine, The Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Carroll
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Hadland
authors.affiliation: Department of Emergency Medicine, Boston University School of Medicine, 771 Albany Street, Boston, MA 02118, USA; Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA; Injury Prevention Center, Boston Medical Center, 771 Albany Street, Dowling South 1, Boston, MA 02118, USA.
authors.forename: Traci C
authors.initials: TC
authors.lastname: Green
authors.affiliation: The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI 02906, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA. Electronic address: brandon_marshall@brown.edu.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid; D005260:Female; D005283:Fentanyl; D007722:Health Knowledge, Attitudes, Practice; D003932:Heroin; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010865:Pilot Projects; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D015995:Prevalence; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin; D005283:Fentanyl
keywords: Fentanyl; Heroin; Non-medical prescription opioid use; Young adults