title: Exploring synthetic heroin: Accounts of acetyl fentanyl use from a sample of dually diagnosed drug offenders.
abstract: Acetyl fentanyl, a fentanyl analogue emerging onto the recreational drug scene, has been responsible for numerous recent fatal overdoses in the USA, Europe and Russia. Studies reporting acetyl fentanyl use are presently limited to case studies and mortality reports. This study explores the nature of acetyl fentanyl use through the collection of first-hand qualitative data from users to inform public health and drug control policy responses.
  
  
  
  A series of focus group interviews within a correctional setting-Delaware County (Ohio) Jail, USA. Participants were 102 individuals in one of two US Bureau of Justice Assistance Second Chance Act substance use treatment initiatives participating in at least one focus group session. Five of these individuals reported acetyl fentanyl use. Semi-structured qualitative focus group sessions queried subjects' drugs of choice and nature of drug use. Responses were explored through follow-up organic discourse.
  
  
  
  Acetyl fentanyl users were generally unaware that they had administered the substance until after use (initially believing that they were administering heroin). They described the effects of acetyl fentanyl as stronger and qualitatively different from heroin. These individuals showed no interest in using acetyl fentanyl again describing it as unpleasant and more risky, both because of potency and the threat of a 'bad batch'.
  
  
  
  Acetyl fentanyl is reaching heroin users, some of which administer it unknowingly. Regulation of acetyl fentanyl is recommended in all countries as is increasing public awareness that the substance is distinct from and being sold as heroin. [Miller JM, Stogner JM, Miller BL, Blough S. Exploring synthetic heroin: Accounts of acetyl fentanyl use from a sample of dually diagnosed drug offenders. Drug Alcohol Rev 2018;37:121-127].
authors.affiliation: Department of Criminology and Criminal Justice, University of North Florida, Jacksonville, USA.
authors.forename: J Mitchell
authors.initials: JM
authors.lastname: Miller
authors.affiliation: Department of Criminal Justice and Criminology, University of North Carolina Charlotte, Charlotte, USA.
authors.forename: John M
authors.identifier: 0000-0003-2821-1494
authors.initials: JM
authors.lastname: Stogner
authors.affiliation: Department of Criminal Justice and Criminology, Georgia Southern University, Statesboro, USA.
authors.forename: Bryan Lee
authors.initials: BL
authors.lastname: Miller
authors.affiliation: School of Criminal Justice and Social Sciences, Tiffin University, Tiffin, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Blough
mesh_terms: D017831:Diagnosis, Dual (Psychiatry); D005283:Fentanyl / Q000031:analogs & derivatives*; D017144:Focus Groups; D006801:Humans; D009042:Motivation; D009293:Opioid-Related Disorders; D036301:Qualitative Research
chemical_list: C000594854:N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide; D005283:Fentanyl
keywords: China white; acetyl fentanyl; black shadow; desmethyl fentanyl; synthetic heroin