Survey of local patterns of fentanyl exposure and harm reduction strategies in the Southeastern United States

Introduction: Fentanyl, a synthetic opioid, is frequently found as a contaminant in illicit substances, significantly increasing overdose risk. A growing trend toward intentional fentanyl use further complicates the opioid crisis. This study aimed to identify patterns of local fentanyl use and contamination and evaluate harm-reduction interventions provided by psychiatric teams to patients at high risk of opioid overdose. Methods: This observational study combined prospective surveys with retrospective chart review. Adults with a positive fentanyl urine drug screen within 6 months of a psychiatric hospitalization or emergency department encounter were eligible. Participants completed a 10-question survey on substance use patterns, fentanyl risk awareness, and willingness to engage with harm-reduction tools. Electronic health records were reviewed upon patient discharge for demographic and clinical data, including prescribed harm reduction interventions. Results: Eighteen participants completed the survey; 77.8% were male with a mean age of 41 years. Intentional fentanyl use was reported by 77.8% of participants. Commonly codetected substances included amphetamines (44.4%), cannabinoids (38.9%), cocaine (33.3%), and other opioids (27.8%). Whereas more than 90% recognized the overdose risk from fentanyl, nearly half did not perceive themselves to be at personal risk. Most participants were discharged with naloxone (88.9%) and/or prescribed medication for opioid use disorder. Willingness to use fentanyl test strips was high (72.2%). Discussion: The findings of this study underscore the need for the increased availability of harm-reduction strategies, including fentanyl detection tools and tailored education, to address gaps in overdose risk perception and enhance patient safety.