Estimating the Risk of Exposure to Fentanyl in New York City: Testing Drug Residue in Used Syringes.

OBJECTIVES: To estimate the risk of exposure to fentanyl among syringe exchange program (SEP) participants in New York City. METHODS: We recruited a convenience sample from 11 SEPs in New York City between March and June 2017. Consenting participants (n = 434) received a labeled syringe for their next injection. We tested collected syringes with gas chromatography-mass spectrometry and liquid chromatography-quadrupole-time-of-flight mass spectrometry. Fentanyl or fentanyl analogs detected in quantities greater than 10% of the residue mass were reported. RESULTS: The final analysis included 271 syringes; 46 (17.0%) contained fentanyl or a fentanyl analog. Fentanyl was the most frequently identified fentanyl compound, identified in 36 (13.3%) syringes. Furanylfentanyl was detected in 10 (3.7%) syringes, and 4-fluoroisobutyryl fentanyl was detected in 5 (1.8%) syringes. CONCLUSIONS: The risk of exposure to fentanyl in syringes used by SEP participants was significantly lower significantly lower than the amount of fentanyls identified among overdose decedents in New York City. Further research is needed to understand how people who use drugs have adapted to fentanyl in the drug market. Understanding the risk of exposure to fentanyls is critical to development of targeted public health messaging.

Intensity of Binge Drinking a Decade After the September 11th Terror Attacks Among Exposed Individuals.

INTRODUCTION: The 9/11 terrorist attacks on the World Trade Center resulted in elevated post-traumatic stress disorder (PTSD) and alcohol use among exposed individuals. The relationship among traumatic exposure, PTSD, and excessive drinking is well documented; however, little is known about these relationships in the long term. This study examines factors increasing binge drinking risk among exposed individuals a decade post-9/11. METHODS: In 2015-2016, data were analyzed from 28,592 World Trade Center Health Registry enrollees aged ≥18 years who completed the Wave 3 (2011-2012) survey. Women comprised 38.9% of participants. Binge drinking in the last 30 days was categorized as low (men, five to seven drinks; women, four to six drinks) or high intensity (men, eight or more drinks; women, seven or more drinks). Probable 9/11-related PTSD was defined as scoring ≥44 on the PTSD Checklist. Exposures to 9/11 (e.g., witnessing horror, sustaining an injury) were categorized as none/low (zero to two) or high (three or more). RESULTS: Binge drinking was reported by 24.7% of participants, of whom 36.9% reported high-intensity binge drinking. Compared with non-binge drinkers, the odds of low- and high-intensity binge drinking were greater among enrollees who were male, aged 18-34 years, non-Hispanic white, had income >$75,000, were rescue/recovery workers, had high 9/11 exposure, or 9/11-related PTSD. CONCLUSIONS: The observed associations among traumatic exposure, PTSD, and excessive drinking underscore the need for improved therapies addressing excessive drinking and PTSD concurrently, inclusion of repeated post-event screening for excessive drinking, and evidence-based population-level interventions to reduce alcohol consumption.