A scoping review of the opioid epidemic among U.S. Immigrants: Implications for treatment practices.

The purpose of this review was to identify knowledge gaps within the literature regarding the impact of opioid use disorder, specific to immigrants in the United States, by addressing the following questions: 1) What is presented in the literature about the impact of opioid use disorder (OUD) and the opioid epidemic on immigrants in the United States?; and 2) What role does culture play in the opioid use disorder experiences of immigrants in the United States? Nineteen research articles were uncovered that addressed immigrants in the U.S. and opioid use disorder. The following themes prevailed: 1) OUD comparisons, 2) OUD comorbidities, 3) disparate OUD treatment engagement, and 4) the role of country of origin. Limited review findings support the need for future research on the topic of opioid misuse among immigrants in the United States. The authors elaborated on additional issues that influence OUD rates and warrant further exploration. Matters related to the potential positive roles of religion and faith leaders, cultural perceptions and expectations about gender roles, immigration status, ethnically diverse needs among sub-groups of immigrants, the role of geographic location within the U.S., and the implications of COVID-19 on OUD among immigrants need to be addressed to alleviate the deleterious impact of opioid misuse among immigrants.

"You Never Know What You're Getting": Opioid Users' Perceptions of Fentanyl in Southwest Pennsylvania.

BACKGROUND: Urban areas in the United States have experienced a dramatic surge in fentanyl overdose deaths since 2014, a trend affecting both larger and smaller metropolitan areas. Encompassing only 1.2 million residents, Allegheny County, Pennsylvania, nevertheless saw 412 fentanyl-involved deaths in 2016, a number surpassed only by New York City and Cook County (Chicago), Illinois. OBJECTIVES: This article seeks to describe opioid users' perceptions of fentanyl in Allegheny and three adjacent counties; it further considers how the drug's emergence shapes some users' market behaviors and consumption practices. METHODS: This article reports on qualitative interview data (N = 30) collected as part of a larger, multi-phase, mixed methods study (N = 125) among individuals reporting past-year prescription opioid misuse or heroin use in four southwest Pennsylvania Counties. RESULTS: Most interviewees reported past-year suspected exposure to fentanyl, and many reported suffering or seeing suspected fentanyl overdoses. Where roughly one-third reported strategies for avoiding fentanyl, a small group of interviewees identified advantages to fentanyl, while still acknowledging its associated risks. Conclusions/Importance: Given users' diverse opinions around fentanyl, the distribution of fentanyl test strips may represent an effective response to the current crisis.

Opioid misuse initiation: Implications for intervention.

The nonmedical use of opioids (e.g., prescription painkillers and heroin) has drastically increased over the past two decades. Despite the popular media narrative suggesting initiation often begins with misused personal prescriptions, there has been surprisingly little investigation into how persons initiate their misuse of opioids. Inattention to initiation patterns is an important limitation because understandings of onset directly inform prevention and treatment interventions. The primary goals of this study, therefore, were to: (1) describe the age patterns of opioid misuse initiation, (2) identify the opioid most commonly used at initiation and the source of the initial opioids, and (3) explore the narrative accounts of the circumstances surrounding opioid misuse onset. Surveys (n = 125) and in-depth interviews (n = 30) were conducted with nonmedical opioid users currently residing in southwest Pennsylvania between July 2017 and July 2018. Survey results show that initiation of opioid misuse (both heroin and prescription opioids) tends to occur prior to age 25, peaking between the ages of 18-25, with most (81%) initiating with prescription opioids. Qualitative findings provided additional context regarding the timing of initiation, acquiring opioids at initiation, and motivations for initiating. This study adds to the limited research on opioid misuse initiation and provides insights to drug treatment providers, prescribers, and public health professionals in identifying who is at risk for opioid misuse initiation, and more importantly, when and how to intervene most effectively.