Emergence of Wasp Dope in Rural Appalachian Kentucky

Abstract

Background and aim:

Recent reports have highlighted the emergence of “wasp dope” as an issue of concern, but epidemiologic evidence is lacking. Wasp dope is a crystalline substance created by electrifying pyrethroid-containing insecticides (e.g., wasp sprays) that may give users a methamphetamine-like “rush”. This paper describes wasp dope use and correlates of use in a sample of people who use drugs (PWUD) in Appalachian Kentucky, a region that has been an epicenter of opioid use and related harms in the US.

Methods:

Respondent-driven sampling and targeted street outreach were used to recruit PWUD. Eligibility criteria included being at least 18 years old, residing in one of five Appalachian Kentucky counties, and having either used opioids or injected any drug to get high in the prior 30 days. Interviewer-administered surveys queried participants’ (n=278) recent (past 6 month) wasp dope use, other substance use, and demographic characteristics. Prevalence ratios were estimated using generalized estimating equations assuming a Poisson outcome distribution in a cross-sectional analysis.

Results:

Recent wasp dope use was reported by 16.1% of participants. Men and people who recently experienced homelessness and transportation difficulties were twice or more as likely to have used wasp dope compared with their counterparts (PR=2.08 95%CI[1.11, 3.87], PR=2.78 95%CI[1.64, 4.72], and PR=2.01 95% CI[1.06–3.81], respectively). While wasp dope use was associated with injection drug use and using opioids and other substances to get high in unadjusted analyses, the factor most strongly associated with wasp dope use was methamphetamine use (PR=17.23 95%CI[2.57, 115.61]), specifically methamphetamine injection (PR=4.47 95%CI[1.56, 12.78]).

Conclusions:

Among people who use drugs in rural Kentucky, USA, nearly one in six people surveyed reported using wasp dope in the past 6 months, rivaling the percentage using cocaine/crack and fentanyl/carfentanil use. Wasp dope use was higher among men and strongly associated with homelessness, transportation access, methamphetamine use, and injection drug use

Introduction

Media reports^1–6, substance use forums^7–10, and poison control websites¹¹ have noted the emergence of “wasping” or use of “wasp dope” as a public health concern. Wasp dope is made by electrifying insecticides containing pyrethroid (i.e., certain hornet and wasp sprays) via spraying it on a metal screen and attaching a battery. The resulting substance (also referred to as “wasp”, “shock dope”, “hot shots”) resembles crystal methamphetamine in appearance and may be used directly or mixed with methamphetamine or other drugs. Other forms of wasp dope (referred to as “KD”, “Katie”, and “zombie”) involve directly spraying the insecticides on other substances (i.e., marijuana, tobacco, spice) before use. Media reports have reported overdoses, erratic behavior, and hallucinations following wasp dope use,^1–5 though the mechanism of action is unknown and polysubstance use complicates attribution of effects.

Relatively little is known about the pharmacokinetics and short- and long-term effects of wasp dope. Pyrethroids are known to produce potent sympathetic activation, salivation, hyperexcitability, choreoathetosis, and seizures¹² and are likely responsible for giving wasp dope users a “rush.” Pyrethroids have a half-life of tens of hours¹² and in animal studies of toxicity have produced elevated plasma levels of adrenaline and noradrenaline,^12,13 potentially contributing to wasp dope’s reported effects .¹⁴

To our knowledge, there is no published epidemiological or behavioral research on the use of wasp dope, only a letter to an editor,¹⁵ a few case reports,^14,16 and a conference abstract describing inhalation with synthetic cannabinoids.¹⁷ The letter to the editor described a 56-year-old man hospitalized in Tennessee following multiple wasp dope injections after being unable to obtain methamphetamine due to cost. While delirium and confusion persisted for the first three days of hospitalization, the authors were reluctant to attribute the symptoms to wasp dope given the timing of use. Interestingly, the authors reported that the man had acute hepatitis A and B and liver failure and noted that these conditions’ impact on pyrethroid’s effects and metabolism is unclear.¹⁵

Case reports from Texas revealed very similar situations involving two young adult men with a history of methamphetamine use.^14,16 In one case, the man transitioned to inhaling or smoking crystalized cockroach killer containing pyrethroid when he became unable to afford methamphetamine. The man reported a methamphetamine-like high, olfactory hallucinations, increased heart rate, and suicidal ideation, though the latter may have been due to untreated bipolar disorder.¹⁴ The other case involved intravenous use of a pyrethroid-containing compound, but details of his transition to wasp dope use and its reported effects were lacking.¹⁶

These cases and media reports point to potential emergence of wasp dope as a novel drug of abuse potentially associated with methamphetamine and disruptions in its supply; however, the lack of epidemiological research on the topic makes it unclear how widespread use may be. This paper describes wasp dope use and correlates among people who use drugs (PWUD) in Appalachian Kentucky, a region that has been an epicenter of opioid use and related harms in the US.

Methods

Study Design

The Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) study is a mixed methods study designed to build community-grounded, evidence-based responses to opioid use disorder and related harms in rural Kentucky. CARE2HOPE involves engagement with local coalitions and advisory boards, with the latter made up of PWUD. In September 2018 (approximately six months after enrollment began), participants and advisory board members began anecdotally reporting that methamphetamine dealers were cutting their crystal methamphetamine with “wasp dope”. Participants reported not knowing that the methamphetamine they purchased contained it until they used it and experienced adverse effects. In response, in November 2018, the CARE2HOPE team added survey questions to the 6-month and 12-month follow-up surveys to assess wasp dope use (described in Measures section below).

Eligibility criteria for cohort participants included being 18 years or older, residing in one of five Appalachian Kentucky counties, and having either used opioids to get high or injected any drug to get high in the prior 30 days. Participants were recruited through respondent-driven sampling (RDS) between February 2018 and April 2019.^18,19 Well-connected participants recruited from a previous study of young PWUD in the area²⁰ and from targeted outreach served as seeds for RDS.

Measures

The dependent variable was recent wasp dope use measured with the question, “Have you used ‘wasp dope’ in the past 6 months? Wasp dope is what some people consider a type of homemade methamphetamine.” Originally, the question stem described wasp dope in more detail, but during piloting staff voiced concern that providing too much information could prompt participants to try to make it. Staff and board members felt that the term “wasp dope” was distinctive enough to avoid confusion with other forms of homemade methamphetamine. Because the wasp dope measure was added partway through the 6-month survey, some participants were asked about wasp dope for the first time during the 12-month survey. To provide maximal data, we constructed our analysis sample by including everyone who was asked about wasp dope during the 6-month survey and for the first time during the 12-month survey.

Given the scarcity of research, we conducted an exploratory analysis examining associations between wasp dope use and recent substance use (i.e., past 6 month), injection drug use, and demographic and socioeconomic indicators measured at baseline (age, gender, education, income, homelessness, transportation access, and rurality). Homelessness was defined as “living from place-to-place, couch-surfing, on the street, in a car, park, abandoned building, tent, campsite, squat or shelter.” Transportation access was defined by a response to: “In the past 6 months, have you been unable to do something you needed to do because you did not have a way to get there?”. Rurality and socioeconomic indicators were examined because they could impact drug availability and affordability, both of which emerged as factors in prior case studies.^14,15 Rurality was examined at the county-level using a three-level variable corresponding to counties’ Rural-Urban Continuum Codes (RUCC) which classifies counties on a scale from 1 (most urban) to 9 (most rural).²¹ Three of the five study counties were classified as RUCC 9, one was classified as RUCC 8, and one was classified as RUCC 7. Race and ethnicity could not be examined due to homogeneity in the sample (97.6% were white and 99.7% were non-Hispanic, mirroring the underlying demographic profile of the area population). All sociodemographic measures were based on responses at baseline.

Analysis

Prevalence ratios were estimated for the relationship between wasp dope use with demographic and drug use predictors. Prevalence ratios (PRs) were estimated using generalized estimating equations (GEE) assuming a Poisson distribution with a log link. Poisson regression was preferred over log binomial models to improve model stability.²² GEE allowed us to estimate standard errors robust to both clustering due to the RDS seed and the misspecification of the outcome distribution. All models controlled for survey wave. Given that associations between wasp dope use and other substances may be confounded by methamphetamine use, models controlling for both survey wave and methamphetamine use were analyzed for all substance use predictors. Proportions and corresponding cluster-robust confidence intervals were estimated in SAS PROC SURVEYFREQ. Due to low item nonresponse (6%−7%) across models, all analyses were treated as complete case analyses. The analysis plan was not pre-registered on a publicly available platform and the findings should be considered exploratory.

Results

Demographic and behavioral characteristics of the sample (n=278) and characteristics’ associations with wasp dope use are described in Tables 1 and 2. Briefly, 56% were male and the average age was 36.3 (SD=8.7, Range=21–64). Overall, 59% had injected drugs in the past 6 months and the most commonly reported substances recently used to get high were methamphetamine (70%) and heroin (53%).

Table 1.

Demographic characteristics and wasp dope use among a sample of people who use drugs (n=278) in rural Appalachian Kentucky

Characteristic	Overall % (95% CI)	Used wasp dope in past 6 months % (95% CI)	PR (95% CI)	p-value
Sex
Female	43.8 (38.4, 49.3)	9.8 (4.3, 15.3)	REF
Male	56.2 (50.7, 61.6)	21.1 (14.1, 28.1)	2.08 (1.11, 3.87)	0.021
Age
< 30 years	26.7 (21.5, 31.9)	20.8 (11.2, 30.5)	REF
30 – 44 years	57.0 (51.2, 62.9)	14.4 (8.5, 20.3)	0.69 (0.39, 1.23)	0.207
45 years and older	16.2 (11.7, 20.8)	14.3 (3.4, 25.1)	0.68 (0.3, 1.56)	0.364
Education completed
Less than high school	31.0 (25.3, 36.8)	15.9 (7.7, 24)	REF
High school	42.6 (36.8, 48.4)	17.1 (9.9, 24.3)	1.02 (0.55, 1.92)	0.940
More than high school	26.4 (21.0, 31.7)	14.9 (5.5, 24.3)	0.89 (0.4, 1.98)	0.781
Monthly Income (USD)
$500 or less	51.1 (45.0, 57.2)	20.0(12.8, 27.2)	REF
More than $500	48.9 (42.8, 55.0)	12.0 (6.2, 17.8)	0.64 (0.36, 1.14)	0.128
Ruralitya
Least rural	58.8 (51.2, 66.5)	17.0 (10.4, 23.5)	REF
Moderately rural	18.1 (12.7, 23.4)	10.4 (1.7, 19.1)	0.63 (0.27, 1.5)	0.297
Most rural	23.1 (16.3, 29.9)	18.6 (9.3, 28.0)	1.13 (0.61, 2.1)	0.706
Homelessness in past 6 months
No	63.9 (58.3, 69.5)	9.8 (4.9, 14.6)	REF
Yes	36.1 (30.5, 41.7)	27.1 (18.4, 35.8)	2.78 (1.64, 4.72)	<0.001
Transportation difficulties in past 6 months
No	40.8 (35.0, 46.6)	10.1 (3.9, 16.3)	REF
Yes	59.2 (53.4, 65.0)	20.5 (13.9, 27.2)	2.01 (1.06, 3.81)	0.033

REF: reference group; PR: prevalence ratio; CI: confidence interval;

^*indicates p<0.05

^aDefined by USDA Rural-urban Continuum Code (RUCC), with “least rural” being RUCC=7, “moderately rural” being RUCC=8, and “most rural” being RUCC=9.

Table 2.

Recent substance use and wasp dope use among a sample of people who use drugs (n=278) in rural Appalachian Kentucky

Substance use to get high in past 6 months	Overall % (95% CI)	Used wasp dope in past 6 months % (95% CI)	PR (95% CI)	p-value
Alcohol
No	72.6 (67.3, 77.8)	17.2 (11.8, 22.6)	REF
Yes	27.4 (22.2, 32.7)	13 (5, 21.1)	0.73 (0.38, 1.40)	0.337
Heroin
No	47.4 (41.3, 53.4)	8.8 (3.8, 13.8)	REF
Yes	52.6 (46.6, 58.7)	22.8 (15.2, 30.4)	2.92 (1.61, 5.30)	<0.001
Street fentanyl / carfentanil
No	75.2 (69.8, 80.5)	12.6 (7.7, 17.4)	REF
Yes	24.8 (19.5, 30.2)	27.4 (15.6, 39.3)	2.34 (1.38, 3.97)	0.002
Prescription opioids
No	60.9 (54.6, 67.2)	12.6 (7.5, 17.6)	REF
Yes	39.1 (32.8, 45.4)	21.6 (13.1, 30.1)	1.74 (1.04, 2.93)	0.036
Buprenorphinea
No	66.5 (60.8, 72.2)	9.3 (4.9, 13.7)	REF
Yes	33.5 (27.8, 39.2)	29.2 (19.2, 39.2)	3.18 (1.83, 5.53)	<0.001
Methadonea
No	96.6 (94.5, 98.8)	15.9 (11.1, 20.6)	REF
Yes	3.4 (1.2, 5.5)	22.2 (0, 49.7)	1.48 (0.46, 4.76)	0.506
Prescription sedatives
No	69.9 (64.3, 75.5)	11.5 (6.5, 16.5)	REF
Yes	30.1 (24.5, 35.7)	26.9 (16.7, 37.1)	2.36 (1.38, 4.03)	0.002
Cocaine/crack
No	80.5 (76.0, 84.9)	12.4 (7.7, 17.1)	REF
Yes	19.5 (15.1, 24.0)	30.8 (17.9, 43.7)	2.60 (1.58, 4.27)	<0.001
Methamphetamine
No	30.5 (24.8, 36.1)	1.2 (0, 3.7)	REF
Yes	69.5 (63.9, 75.2)	22.8 (16.3, 29.2)	17.23 (2.57, 115.61)	0.003
Gabapentin
No	65.4 (59.7, 71.2)	11.1 (6.5, 15.7)	REF
Yes	34.6 (28.8, 40.3)	25.6 (15.8, 35.3)	2.31 (1.37, 3.89)	0.002
Clonidine
No	93.6 (90.8, 96.4)	14.8 (10, 19.5)	REF
Yes	6.4 (3.6, 9.2)	35.3 (12.3, 58.2)	2.56 (1.37, 4.8)	0.003
Kratom
No	92.9 (89.9, 95.8)	16 (11.2, 20.7)	REF
Yes	7.1 (4.2, 10.1)	17.6 (0, 36)	1.12 (0.43, 2.91)	0.817
Bath salts
No	93.2 (90.2, 96.3)	12.8 (8.3, 17.2)	REF
Yes	6.8 (3.7, 9.8)	61.1 (38.4, 83.9)	4.75 (2.86, 7.88)	<0.001
Synthetic marijuana
No	91.4 (88, 94.7)	13 (8.6, 17.5)	REF
Yes	8.6 (5.3, 12.0)	47.8 (27.2, 68.5)	3.71 (2.26, 6.09)	<0.001
Any injection drug use
No	41.0 (34.6, 47.3)	4.7 (0.6, 8.7)	REF
Yes	59.0 (52.7, 65.4)	24 (17, 31)	4.92 (2.09, 11.60)	<0.001
Any snorted drug use
No	58.9 (52.8, 64.9)	15 (9.3, 20.8)	REF
Yes	41.1 (35.1, 47.2)	17.8 (10.2, 25.3)	1.29 (0.76, 2.20)	0.343

REF: reference group; PR: prevalence ratio; CI: confidence interval;

^aSpecifically refers to reported use of substance “to get high” and not to use of substance as prescribed by a healthcare provider for treatment of opioid use disorder

One-sixth of participants (n=42, 16%) reported using wasp dope in the past 6 months. As shown in Table 1, men and those experiencing recent homelessness, and those with recent transportation difficulties were significantly more likely to have recently used wasp dope compared to their counterparts (PR=2.08 95%CI[1.11, 3.87], PR=2.78 95%CI[1.64, 4.72], and PR=2.01 95% CI[1.06–3.81], respectively) . Wasp dope was most strongly associated with recent injection drug use (PR=4.92 95%CI[2.09, 11.60]) and methamphetamine use (PR=17.23 95%CI[2.57, 115.61]), though it was also associated with use of various other substances (see Table 2). In analyses controlling for concurrent methamphetamine use (Table 3), use of various opioids, cocaine/crack, clonidine, bath salts, synthetic marijuana, prescription sedatives, remained significantly associated with wasp dope use. Of note, among those using methamphetamine (n=185), 71% were injecting it and methamphetamine injection was significantly associated with wasp dope use (PR=4.47 95%CI[1.56, 12.78]) , though other routes of administration (i.e., smoking and snorting) were not (data not shown in table).

Table 3.

Recent substance use and wasp dope use among a sample of people who use drugs, controlling for concurrent methamphetamine use (n=278) in rural Appalachian Kentucky

Substance use to get high in past 6 months	APR (95% CI)	p-value
Alcohol (Yes vs no)	0.69 (0.34, 1.40)	0.301
Heroin (Yes vs no)	1.86 (1.04, 3.32)	0.037
Street fentanyl / carfentanil (Yes vs no)	1.72 (1.02, 2.89)	0.042
Prescription opioids (Yes vs no)	1.22 (0.72, 2.06)	0.46
Buprenorphinea (Yes vs no)	2.27 (1.28, 4.02)	0.005
Methadonea (Yes vs no)	1.19 (0.38, 3.75)	0.762
Prescription sedatives (Yes vs no)	2.01 (1.20, 3.37)	0.008
Cocaine/crack (Yes vs no)	1.83 (1.10, 3.04)	0.02
Gabapentin (Yes vs no)	1.56 (0.94, 2.60)	0.085
Clonidine (Yes vs no)	2.16 (1.20, 3.89)	0.011
Kratom (Yes vs no)	0.89 (0.37, 2.18)	0.806
Bath salts (Yes vs no)	3.26 (1.95, 5.44)	<0.001
Synthetic marijuana (Yes vs no)	3.00 (1.88, 4.79)	<0.001
Any injection drug use (Yes vs no)	2.20 (0.97, 4.99)	0.058
Any snorted drug use (Yes vs no)	0.85 (0.50, 1.44)	0.544

APR: adjusted prevalence ratio; CI: confidence interval;

^aSpecifically refers to reported use of substance “to get high” and not to use of substance as prescribed by a healthcare provider for treatment of opioid use disorder

Discussion

One in six (16%) rural Appalachian PWUD in this study reported using wasp dope in the past 6 months. To our knowledge, this is the first epidemiologic study of wasp dope use in a sample of PWUD. Given the scarcity of literature on the topic, the proportion of the sample using wasp dope is higher than expected, nearing that of recent cocaine/crack use (20%) and street fentanyl/carfentanil use (25%).

This study revealed that wasp dope use was associated with recent use of various other drugs, even after controlling for concurrent methamphetamine use. Methamphetamine use was most strongly associated with wasp dope use, with those who had recently used methamphetamine having 17 times higher likelihood of recent wasp dope use compared to their counterparts. Interestingly, when methamphetamine use by route of administration was examined, only methamphetamine injection was associated with wasp dope use. Almost 30% of people who had injected methamphetamine used wasp dope compared to only 6% of their counterparts.

Case reports suggest people began using wasp dope when they were unable to afford or access methamphetamine.^14,15 While wasp dope use was not significantly associated with education and income, homelessness and transportation access did emerge as strongly associated factors. More than 25% of individuals recently experiencing homelessness used wasp dope in the past six months, which was more than twice the prevalence of their stably-housed counterparts. Although more research is needed to understand these associations, we hypothesize that limited affordability and accessibility of pure methamphetamine plays a role. Anecdotal reports from the participants and from case reports^14,15 indicate wasp dope use might often be unpleasant and unintentional, involving adulterated crystal methamphetamine. Drug-checking technologies, if developed for pyrethroids, may be worth exploring in future research as a tool to curb unintentional wasp dope use.

Interestingly, existing case reports on wasp dope from the US have predominantly involved men,^14–16 though there are reported cases elsewhere of ingestion by women in which intentionality and/or suicidality was unclear.^23,24 In this study, men were twice as likely to have used wasp dope compared to women. Discussion of findings with community-based staff revealed that the gender difference may be partly due to men testing drugs for purity and strength before sharing them with their female partners, a phenomenon that participants have anecdotally reported during interviews.

To our knowledge, this is the first epidemiologic study describing wasp dope use among PWUD. Though the study is limited by reliance on self-report, wasp dope’s distinct effects likely increase accuracy of reported use. The survey did not query intentionality, and therefore captured suspected_use. Participants may have used wasp dope, recognized the effects as unusual, but not known the cause, resulting in potential under-estimation of use. More quantitative and qualitative research is needed to fully understand factors associated with use and polydrug use involving wasp dope and associated harms. Also, although the use of respondent-driven sampling likely increased the sample’s representativeness of PWUD in the study area, findings may not be generalizable to other regions. Finally, because rurality may shape drug availability and pricing and thereby affordability of methamphetamine, more research is needed to examine whether rurality is a risk factor for wasp dope use given this study sample’s limited variance on rurality.

In summary, one in six PWUD in this study reported using wasp dope in the past 6 months, rivaling the percentage using cocaine/crack and fentanyl/carfentanil use. Wasp dope use was higher among men and strongly associated with homelessness, transportation access, methamphetamine use, and injection drug use. Wasp dope use could be emerging as an issue of public health concern and warrants far more scientific and public attention than it currently receives.