Correlates of Heroin Use, Pharmaceutical Fentanyl Misuse, and Dual Heroin-Fentanyl Use: Evidence from the U.S.

Purpose: The emergence of fentanyl has deepened concerns about the opioid crisis. The shift has created new distinctions in patterns of opioid use, which may be important for prevention and intervention. We examine socio-demographic correlates as well as health and substance use characteristics of different groups of opioid users. Design: We utilized the 2015-2019 National Survey on Drug Use and Health to examine distinctions between groups (n=11,142) of individuals who misuse prescription opioids, use heroin but not fentanyl, misuse pharmaceutical fentanyl but not heroin, and use both heroin and fentanyl. Multinomial and logistic regression models were used to identify these distinctions. Findings: Few socio-demographic differences emerged between the prescription opioid group and pharmaceutical fentanyl misuse group. While those who misuse fentanyl have higher odds of using other drugs and experiencing certain mental health problems than those misusing prescription pills, both the heroin and fentanyl-heroin use groups reported considerably poorer health and substance use indicators relative to those who solely misuse fentanyl. It is also notable that both heroin use groups are more highly associated with cocaine and methamphetamine use than those misusing fentanyl alone. Originality: This study highlights distinctions between pharmaceutical fentanyl users, heroin users, and users of both substances. Implications: While we identify important distinctions between the opioid use groups studied, individuals using both heroin and pharmaceutical fentanyl report the poorest health and substance use characteristics. Important differences between the fentanyl-only group and the group who consume both drugs may have implications for prevention, intervention, and clinical work amidst shifting patterns of opioid use.