ArticleThe International journal on drug policy2017
Heroin uncertainties: Exploring users' perceptions of fentanyl-adulterated and -substituted 'heroin'.
Article in The International journal on drug policy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 152 papers, 1 of them a synthesis that pooled it.
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Who cites it
152 citing papers in PubMed, 1 synthesis or guideline pooled it, 275 citations in OpenAlex.
- Systematic review on intentional non-medical fentanyl use among people who use drugs.Frontiers in psychiatry · 2024Pooled it
- Perception and Correlates of Opioid Overdose Risk Among Overdose Survivors Who Use Nonprescribed Opioids in San Francisco and Boston.Substance use & addiction journal · 2024Trial
- Opioid withdrawal symptoms, frequency, and pain characteristics as correlates of health risk among people who inject drugs.Drug and alcohol dependence · 2020Trial
- Multilevel drivers and constraints of shifts from injecting to smoking opioids and stimulants: A qualitative study from the San Diego-Tijuana border region.Drug and alcohol dependence · 2026Article
- Pharmacokinetics of xylazine and fentanyl in patients presenting to the emergency department after non-fatal opioid overdose.Drug and alcohol dependence · 2026Article
- An Epidemic of Complexity: Polysubstance Use Fatal Overdose Typologies Across Cook County, Illinois, Neighborhoods, 2017‒2022.American journal of public health · 2026Article
- The Donovan Memorial Lecture: 'Fentanyl-Plus': A New Era of Fentanyl Polydrug Combinations in the North American Overdose Crisis.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2026Article
- Stability or versatility: transitions in fentanyl routes of administration.Harm reduction journal · 2025Article
- Syringe service program leader and participant perspectives on reasons for opioid-stimulant co-use in the United States.Drug and alcohol dependence reports · 2025Article
- Examining predictors of substance use and treatment adequacy among formerly incarcerated individuals with a history of opioid and cocaine use: research protocol.Health & justice · 2025Article
- A qualitative study exploring motives for the transition from injecting to smoking drugs in Vancouver, British Columbia.The International journal on drug policy · 2025Article
- Treatment of Inpatient Opioid Withdrawal with Short-Acting Full Agonist Opioids at a Safety-Net Hospital.Journal of general internal medicine · 2025Article
- "All it's gonna tell you is if it has fentanyl or not:" Perceptions of fentanyl and drug checking among first responders and people who use drugs.Journal of substance use and addiction treatment · 2025Article
- Tranq burn: Exploring the etiology of xylazine-related soft tissue injuries.The International journal on drug policy · 2025Article
- Unpredictable Drug Access and its Relevance for Substance Use Disorders: A Critical Review.Perspectives on behavior science · 2025Review
- "I don't know how you can overdose smoking them:" Perceptions of overdose risks among persons who use illicit fentanyl-laced counterfeit pills.The International journal on drug policy · 2025Article
- Differential effects of fentanyl compared to morphine on neuroinflammatory signaling in the brain in EcoHIV-infected mice.Journal of neurovirology · 2025Article
- Overdose education and naloxone distribution among women with a history of OUD transitioning to the community following jail release.Health & justice · 2025Article
- National and regional trends in fentanyl seizures in the United States, 2017-2023.The International journal on drug policy · 2025Article
- Is fentanyl in everything? Examining the unexpected occurrence of illicit opioids in British Columbia's drug supply.Harm reduction journal · 2025Article
92 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThe 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.
methodsA 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.
conclusionMassachusetts' 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.