Understanding opioid overdose risk and response preparedness among people who use cocaine and other drugs: Mixed-methods findings from a large, multi-city study

Abstract

Background: Fatal overdoses involving cocaine (powdered or crack) and fentanyl have increased nationally and in Massachusetts. It is unclear how overdose risk and preparedness to respond to an overdose differs by patterns of cocaine and opioid use. Methods: From 2017 to 2019, we conducted a nine-community mixed-methods study of Massachusetts residents who use drugs. Using survey data from 465 participants with past-month cocaine and/or opioid use, we examined global differences (p < 0.05) in overdose risk and response preparedness by patterns of cocaine and opioid use. Qualitative interviews (n = 172) contextualized survey findings. Results: The majority of the sample (66%) used cocaine and opioids in the past month; 18.9% used opioids alone; 9.2% used cocaine and had no opioid use history; and 6.2% used cocaine and had an opioid use history. Relative to those with a current/past history of opioid use, significantly fewer of those with no opioid use history were aware of fentanyl in the drug supply, carried naloxone, and had received naloxone training. Qualitative interviews documented how people who use cocaine and have no history of opioid use are largely unprepared to recognize and respond to an overdose. Conclusions: Public health efforts are needed to increase fentanyl awareness and overdose prevention preparedness among people primarily using cocaine.

Keywords:

• Substance use
• opioids
• cocaine
• crack
• overdose

Acknowledgment

The authors wish to thank the participants and the community partners who helped to make this research possible. We would also like to thank our study funders, the Centers for Disease Control and Prevention and the Bureau of Substance Addiction Services at the Massachusetts Department of Public Health, with a special thanks to Sarah Ruiz and Brittni Reilly. Finally, we would like to acknowledge the hard work and dedication of the RACK study teams at Boston Medical Center and Brandeis University. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript, approval of the manuscript, and decision to submit the manuscript for publication. MDPH did review the final draft of the manuscript prior to submitting for publication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Dr. Hughto conceptualized the paper, analyzed and interpreted the data, and drafted and edited the manuscript. Ms. Gordon conducted the literature review and edited the paper. All authors helped to interpret the data and contributed to the writing and editing of the manuscript. Drs. Hughto, Stopka, Case, Palacios, and Green are investigators on the parent study and were involved in the collection of the data.

Data availability statement

The data can be made available by emailing the senior author.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study is funded by grant from the Centers for Disease Control and Prevention [CDC; NU17CE002724 (PI: Alawad), NU17CE002724 (PI: Ruiz)] to the Massachusetts Department of Public Health (MDPH), Bureau of Substance Addiction Services supported this research. Dr. Hughto is also supported by COBRE on Opioids and Overdose funded by the National Institute of General Medical Sciences of the National Institutes of Health under [grant number P20GM125507].