Table 4.
Practical responses employed by PWID to avoid harms from injecting fentanyl
| Key Theme | Exemplar Quote |
|---|---|
| Managing Inconsistent Potency | Male, 33: When I first got around fentanyl, my guy told me, he said, ‘Just do a little bit and work your way up.’ And I said, “Why?” He said, ‘Lookout in the parking lot, there’s one of my guys that I just sold it to.’ So I looked over there and his head was leaning out the window, drooling. ‘He did the whole $20; I told him not to,’ [he said]. When you experience different drugs, or what I do when I do a different kind, because a drug dealer will have a certain amount of dope for a good amount of time, and it’ll get switched up, so ya never know. It’s always good to start little and then work your way up….You can OD on just a tenth of a gram. |
| Visual Inspection | Male, 23: Yeah, it took us a while, but we got to the point where we could look at it before doing it and tell if it had fentanyl in it. See, most of it around here…if it’s white or very lightish color, that would technically be fentanyl. If it [the solution] pulls up clear, kind of yellowish color, we can tell it has fentanyl in it. |
| Visual Inspection, Tester Shot | Male, 44: Any time I do go to the dealer and it is something different and he hands it to me, when I dump it out, if it even looks different, I won’t do nearly as much. I’ll do a little bit first to make sure, because it only takes that, just one time, for one batch, you know [to overdose]. Then I know he didn’t step on it, didn’t cut it, or it wasn’t cut before it got to him, so now it’s, you know, triple pure, or more pure than the last stuff. So, any time I do get something different that I do, I don’t do some huge fat shot |
| Recognizing and Responding to Fentanyl Overdose | Male, 34: There were times when we were at the house and she would do a shot. And she’d be fine. And then I would be sitting beside her and I’m doing the next shot and the next time I would feel something hitting [me], and I look over and she’s, you know, foaming at the mouth, and I say, “well, fuck,” and I get up, draw the Narcan up, give it to her, sit back down and I finish drawing up my shot up….I’m not going to get like super excited like, Oh my god, what do I do? “Oh my,” ya know, I got you, don’t worry. I’ve seen it a thousand times and know how and when to respond. |
| Changing Route of Administration | Male, 27: I’m like: “You can’t shoot it,” because she pulled out a needle and I then said again: “I’m not letting you shoot—you’ll die.” And she’s like, “No I won’t. I use heroin [sic] every day and I inject.” And I’m like, “Okay, well if you want me to give it [the ‘heroin’] to you, you’re going to snort it, and I’m going to stand right here beside of you and watch. And if you don’t snort it, I’m going to take it from you, and will not give it to you to shoot because I’m not going to have you dying on the fucking courthouse steps with me beside you.” |
| Tester Shot | Male, 33: You get one-tenth of a gram, you take that one-tenth, and say if you don’t know and your people say it’s really good dope, make sure to break that one-tenth into five little piles and then take one pile and try that. I would inject the first one to see how big of, how high I’ll get off that one. If I didn’t get high off it, then I know I can probably do the whole thing. |
| Using the same seller | Male, 46: We’ve gotten close to our main dealer and we were so tight with him that he would call us to test the dope that he would get and everything like that. We got to the point that we knew exactly what we were getting, we knew if it was going to be all fentanyl or cut with fentanyl…Using the same dealer, you use them over time and it builds a bond of trust, and it’s so much on a dealerto-client basis, you know it more like a personal basis |
| Not Using Alone | Male, 40: Me and my better-half [girlfriend] have a policy that we only get high together so just in case one of use goes out, someone is there [to administer naloxone] |
| Not Using Alone | Male, 33: It’s like if she [my girlfriend] goes off to go get dope and she stops because she’s so dope sick [in withdrawal] and at a store, she calls me; she puts me on speaker phone, she tells me where she’s at. ‘If I don’t hear nothing back from you’ [I say], ‘at least I know where to call an ambulance and where to send them’ |
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These statements were from a single interview involving two PWID who were intimate partners and recorded together. They recounted their experiences by joining and finishing each other’s statements and thus included here as a joint quotation.