This qualitative study aims to detail and contextualize drug use practices, motivations, and experiences related to counterfeit NPF pill use among PWUO in Arizona. Importantly, currently available information on the use of NPF in the form of counterfeit pills is largely limited to law enforcement statistics, clinical case studies, and media stories.
ĭespite the substantial uptick in the opioid overdose mortality in the Southwest, most prior studies on the NPF-related experiences among people who use illicit opioids (PWUO) were conducted in the eastern or midwestern states. Concurrently, NPF-positive overdose fatality cases in Arizona increased over 80% in 2020 compared to 2019.
According to the Arizona Criminal Justice Commission, between 20 retail-level seizures of counterfeit pharmaceutical pills that contain fentanyl increased 764% in Arizona. Located on important drug trafficking routes, Arizona is considered to be the “ground zero” of the evolving NPF epidemic. Increases in counterfeit pill presence have been especially dramatic in Arizona. Since 2020, many states across the USA have registered notable shifts in the illicit market dynamics as NPF is increasingly available in counterfeit pills, not just in powder form and/or as heroin. Instead, powder-type NPF, often sold as heroin or mixed with heroin, became increasingly available, gradually saturating illicit drug markets and in some regions nearly replacing heroin. However, their presence remained relatively restricted. First reports about the counterfeit pills containing fentanyl emerged in the initial phases of the NPF epidemic in 2014–2015. They are designed to look like legitimate pharmaceuticals but may contain fentanyl, other novel synthetic opioids, and/or other drugs. Counterfeit pharmaceuticals are fake pharmaceutical products that are manufactured illegally in clandestine laboratories using pill press machines that are easily accessible through online sources. The new wave of NPF spread is linked to the increased presence of counterfeit pills. The continuing spread of NPF-type drugs shows new geographic patterns with greater increases in the Western part of the country, including Arizona. The worsening of the overdose crisis has been linked to the profound societal and economic impacts of the COVID-19 pandemic and continuing proliferation of non-pharmaceutical fentanyl, fentanyl analogs, and other novel synthetic opioids (NPF). Provisional data from the US Centers for Disease Control and Prevention (CDC) indicate that there were over 100,000 drug overdose deaths in the USA during the 12 months ending in April 2021, almost a 30% increase compared to the year before. Our findings highlight the need for the implementation of novel policy, treatment, and harm reduction approaches to address the growing unpredictability of drug supply and NPF pill-specific risks, attitudes, and behaviors. They were also influenced by conflicting views of social acceptability of pharmaceutical-like drugs, perceived harms of NPF in terms of overdose risks and increased difficulty of quitting, and perceived benefits of switching to the non-injection route of opioid administration (e.g., from injecting heroin to smoking NPF pills). Participant decisions to switch over to more frequent NPF pill use or to maintain some levels of heroin use were shaped by local drug availability trends and personal experiences with NPF effects. The majority indicated first trying NPF pills in the past year, and the first use often occurred in situations of reduced access to heroin or pharmaceutical opioids. Participants noted significant recent increases in the availability of counterfeit NPF pills (“blues,” “dirty oxys”) that were most commonly used by smoking. Out of 22 participants, 64% were male, and 45% were ethnic minorities.
Qualitative interviews were transcribed and analyzed thematically using NVivo.
Interviews were conducted virtually via Zoom. Participants were recruited through referrals by a harm reduction organization, craigslist ads, and referrals by other participants. This qualitative study aims to characterize the motivation and practices of counterfeit NPF pill initiation and use among individuals using illicit opioids in Arizona.īetween October 2020 and May 2021, semi-structured interviews were conducted with 22 individuals meeting the following eligibility criteria: (1) 18 years or older (2) residence in Arizona and (3) use of illicit opioids in the past 30 days and/or opioid use disorder treatment in the past 12 months. The recent wave of NPF spread in the USA has been fueled by an increased presence of counterfeit pills that contain NPF. Worsening of the overdose crisis in the USA has been linked to the continuing proliferation of non-pharmaceutical fentanyl (NPF).
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