Heroin uncertainties: Exploring users' perceptions of fentanyl-adulterated and -substituted 'heroin'
Heroin uncertainties: Exploring users' perceptions of fentanyl-adulterated and -substituted 'heroin'
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DOI：
10.1016/j.drugpo.2017.06.004
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发表时间：
2017-08-01
影响因子：
4.4
通讯作者：
Mars, Sarah G.
中科院分区：
文献类型：
--
作者：
Ciccarone, Daniel;Ondocsin, Jeff;Mars, Sarah G.
背景：近年来，由于合成阿片类药物芬太尼家族对海洛因供应的区域性污染，美国正在经历前所未有的阿片类药物过量流行。自2011年以来，东海岸马萨诸塞州与阿片类药物相关的过量死亡人数增加了两倍多，1374例死亡中有75%的人芬太尼毒理学呈阳性。芬太尼的效力是海洛因的30-50倍，它的存在使海洛因的使用变得更加不可预测。进行了一项快速人种学评估，以了解注射作为“海洛因”出售的毒品的人的看法和经历，并观察毒品及其使用情况。方法：一组民族志学家于2016年6月在马萨诸塞州东北部和新罕布什尔州纳舒厄进行了研究，对海洛因吸毒者进行了定性访谈（n=38）。结果：(1)近4年海洛因的成分和外观发生了变化；（二）海洛因比以前更便宜、更容易获得；(3)海洛因“种类”激增，有几种产品被当作“海洛因”出售。这些药物包括两种类型的海洛因（单独）、芬太尼（单独）和海洛因-芬太尼组合。在缺乏零售级海洛因毒理学信息的情况下，我们的研究注意到芬太尼识别方法的层次结构，其中体现的效果被认为是确定芬太尼存在的最可靠的方法，其次是味道、溶液外观和粉末颜色。本文根据吸毒者的报告提出了一种新的“海洛因”类型。结论：麻州海洛因出现新现象，广泛掺入芬太尼。吸食海洛因的人试图辨别作为海洛因出售的物质，他们对每种形式的偏好各不相同。提出的海洛因类型不准确，但可以通过将使用者的识别与药物毒理学测试相关联来验证。如果得到验证，这种类型将是一种有价值的减少危害的工具。对海洛因掺假适应性的进一步研究可以降低使用海洛因和合成阿片类药物组合的风险。(c) 2017 Elsevier B.V.版权所有
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 30-50X 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. (c) 2017 Elsevier B.V. All rights reserved.