Sociodemographic Characteristics and Drug Use Practices Associated with Fentanyl Use Frequency Among People Who Use Drugs in Rhode Island

Since 2013, fentanyl has dominated unregulated drug supplies in the northeast and has become a key driver of overdose deaths. In this analysis, we sought to identify the characteristics associated with fentanyl use frequency among people who use drugs in Rhode Island. We examined baseline data from the Rhode Island Prescription and Illicit Drug Study, which enrolled participants from August 2020 to February 2023. We used an ordinal logistic regression to identify sociodemographic and drug use characteristics that were associated with prior month fentanyl use frequency, which was categorized as none, less than weekly, or at least weekly. Among 471 participants, 210 (44%) reported no prior month use of fentanyl or drugs containing fentanyl, 121 (26%) reported less than weekly use, and 140 (30%) reported at least weekly use. Of those who reported at least weekly use, 74% reported intentional use. In bivariate analyses, the proportion of participants utilizing harm reduction practices (e.g., fentanyl test strip use, naloxone carriage) increased with fentanyl use frequency in a dose-response manner. In adjusted analyses, prior month injection drug use, fentanyl preference, regular use of crack cocaine, lifetime overdose history, and current enrollment in opioid agonist therapy were significantly associated (p < 0.05) with greater fentanyl use frequency. Fentanyl exposure and intentional fentanyl use were common in the sample. Our findings suggest a need for increased investment in community-based harm reduction services and low-barrier, patient-centered treatment for polysubstance use, including those involving stimulant use disorders.