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. 2022 Nov 1:240:109644.
doi: 10.1016/j.drugalcdep.2022.109644. Epub 2022 Sep 23.

Correlates of recent overdose among people who inject drugs in the San Diego/Tijuana border region

Katie Bailey  1 , Daniela Abramovitz  2 , Thomas L Patterson  3 , Alicia Y Harvey-Vera  4 , Carlos F Vera  5 , Maria Gudelia Rangel  6 , Joseph Friedman  7 , Peter Davidson  8 , Philippe Bourgois  9 , Steffanie A Strathdee  10
Affiliations

Correlates of recent overdose among people who inject drugs in the San Diego/Tijuana border region

Katie Bailey et al. Drug Alcohol Depend. .

Abstract

Background: Along the Mexico-US border, illicitly manufactured fentanyls (fentanyl) have been detected in other illicit drugs, including street opioid formulations known as 'china white.' We studied correlates of recent overdose among people who inject drugs (PWID), focusing on the risk of knowlingly or unknowingly using fentanyl in china white.

Methods: From October 2020 - September, 2021 we surveyed participants in San Diego, California and Tijuana, Mexico and employed Poisson regression to identify correlates of recent overdose.

Results: Of 612 PWID, most were male (74.0 %), Latinx (71.9 %), US residents (67.0 %). Mean age was 43 years. In the last six months, 15.8 % experienced overdose, 31.0 % knowingly used fentanyl and 11.1 % used china white, of whom 77.9 % did not think it contained fentanyl. After controlling for sex and race, factors independently associated with risk of overdose included knowingly using fentanyl, using china white and not believing it contained fentanyl, recent drug rehabilitation, being stopped/arrested by police, and homelessness. Further, PWID who believed china white contained fentanyl were less likely to use it.

Conclusions: Both intentional fentanyl use and unintentional exposure to fentanyl via china white were associated with overdose risk; however, PWID who believed china white contained fentanyl were less likely to use it. These data suggest that advanced drug checking systems should be implemented to empower PWID to avoid dangerous street formulations or to plan their drug use knowing its contents. Other overdose risk factors such as decreased tolerance following drug treatment, police interactions, and homelessness also require urgent intervention.

Keywords: Fentanyl; Injection drug use; Overdose; San Diego; Tijuana; US-Mexico border.

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Conflict of interest statement

Conflict of interest No conflict declared.

Figures

Figure 1.
Figure 1.. Participant beliefs about the contents of china white among people who inject drugs in San Diego, California and Tijuana, Mexico, n=612*
See this image and copyright information in PMC

References

    1. Allen ST, O’Rourke A, White RH, Sherman SG, Grieb SM, 2020. Perspectives on Fentanyl Test Strip Use among People Who Inject Drugs in Rural Appalachia. Substance Use & Misuse 55, 1594–1600. 10.1080/10826084.2020.1753773 - DOI - PubMed
    1. Armenian P, Vo KT, Barr-Walker J, Lynch KL, 2018. Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review. Neuropharmacology, Designer Drugs and Legal Highs 134, 121–132. 10.1016/j.neuropharm.2017.10.016 - DOI - PubMed
    1. Armenian P, Whitman JD, Badea A, Johnson W, Drake C, Dhillon SS, Rivera M, Brandehoff N, Lynch KL, 2019. Notes from the Field: Unintentional Fentanyl Overdoses Among Persons Who Thought They Were Snorting Cocaine — Fresno, California, January 7, 2019. MMWR Morb Mortal Wkly Rep 68, 687–688. 10.15585/mmwr.mm6831a2 - DOI - PMC - PubMed
    1. Arredondo J, Strathdee SA, Cepeda J, Abramovitz D, Artamonova I, Clairgue E, Bustamante E, Mittal ML, Rocha T, Bañuelos A, Olivarria HO, Morales M, Rangel G, Magis C, Beletsky L, 2017. Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana, Mexico. Harm Reduct J 14, 72. 10.1186/s12954-017-0198-2 - DOI - PMC - PubMed
    1. Aubry T, Tsemberis S, Adair CE, Veldhuizen S, Streiner D, Latimer E, Sareen J, Patterson M, McGarvey K, Kopp B, Hume C, Goering P, 2015. One-Year Outcomes of a Randomized Controlled Trial of Housing First With ACT in Five Canadian Cities. PS 66, 463–469. 10.1176/appi.ps.201400167 - DOI - PubMed

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