By Maureen Salamon
But most opioid addicts are not actively seeking out the potentially lethal painkiller. Instead, they're terrified by the increasing contamination of the illicit drug supply by fentanyl, investigators said.
"I never found the idea that fentanyl was some sort of honeypot that people were scrambling to get hold of very compelling," said study author Jennifer Carroll, a medical anthropologist at Brown University's Warren Alpert Medical School in Providence, R.I. "I hope we can begin chipping away at the narrative that the opioid crisis is driven by people chasing some sort of ultimate high. That's an idea that has never matched reality."
Opioids are a class of drugs that include the illicit drug heroin as well as prescription pain relievers such as morphine, oxycodone (OxyContin), hydrocodone (Vicoprofen), codeine and others. Opioid overdoses now kill 91 Americans each day, according to the U.S. Centers for Disease Control and Prevention.
More than 6 in 10 overdose deaths in the United States involve opioids, the CDC says, and the number of opioid overdose deaths has quadrupled nationally since 1999.
Fentanyl is particularly lethal, because it's a synthetic opioid that's up to 100 times more potent than morphine.
Teams of researchers from Brown University tackled the issue of fentanyl misuse from two vantage points -- mapping its contribution to overdose deaths in Rhode Island while giving voice to drug abusers facing the danger.
One study showed the number of fentanyl-involved overdose deaths rose to 138 in the first nine months of 2016, compared to 84 in all of 2014. Additionally, fentanyl was involved in 56 percent of the state's drug deaths by 2016, compared to 35 percent in 2014.
"It's really alarming," said study author Brandon Marshall, an assistant professor of epidemiology at Brown. "We thought we would see hot spots [of fentanyl overdoses] in lower-income or marginalized communities, but found . . . the risk is really distributed throughout communities."
Fentanyl-laced drugs are increasingly part of the illicit drug supply, not only in heroin but cocaine and prescription painkillers being sold on the street, Marshall said. But many drug abusers can't tell if fentanyl is in their drug, resorting to various attempts to avoid it. A quantity of fentanyl equivalent to two grains of salt can kill.
In the other study, Carroll's team found that 80 percent of the 149 drug users they surveyed and interviewed feared and disliked fentanyl. But many said it was difficult to avoid, and half of those who said they were wary also said they'd been exposed to fentanyl.
The scenarios laid out by drug abusers during study interviews paint a grim picture.
"I've seen people OD in front of me from shooting the stuff," said Matt, a man in his 20s. "People are dropping like flies. I've had three friends I grew up with since I was 10. They're all dead from [heroin cut with fentanyl]."
One drug abuser said he would risk using heroin laced with fentanyl -- trying a little at first to determine if he feels fentanyl's strong effects -- when he's struggling with heroin withdrawal symptoms.
"If I'm sick, I gotta do it, you know?" the man, Jason, told researchers. "I'll do a little pinch and I'll figure it out from there, but I won't start big. It's scary. I've watched overdoses. And I've had one in front of my girl."
Brad Lander is clinical director of addiction medicine at Ohio State University Wexner Medical Center. He said he was surprised the fentanyl overdose numbers in the study weren't even higher, based on what he's seen in his area of the country.
"It's so underground, and the people doing it know there are dangers to it . . . they care but it doesn't stop them," said Lander, who wasn't involved with the new research.
Marshall and Carroll identified several tactics that may help prevent deadly fentanyl overdoses, including making the overdose-reversing drug naloxone more accessible to drug users and their friends and loved ones.
"The issue here is we do have effective interventions . . . [but] we need to implement those programs at a sufficient scale and make them broadly accessible for those at risk for overdose and struggling with addiction," Marshall said.
Carroll urged compassion for drug users and ending the conventional thinking that they are "bad people."
"I hope [our research] is able to humanize drug users and reveal they're just ordinary people facing really unique challenges and just as deserving of compassion, care, tolerance and empowerment as anyone else," she said.
The studies were published online recently in the International Journal of Drug Policy.