Table 2.

Overdose Risk Profiles by Substance Use Behaviors in a Sample of Massachusetts Residents Who Use Drugs, 2017–2019.

Awareness of fentanyl in drug supply	Total		Current cocaine use – no opioid use history		Current cocaine use – opioid use history		Current opioid use		Current cocaine and opioid use		Test statistic p-Value
	N = 465		N = 37		N = 35		N = 88		N = 305
	N	%	N	%	N	%	N	%	N	%
Fentanyl awareness
No/Don’t know	15	3.2	6	16.2	1	2.9	3	3.4	5	1.6
Yes	450	96.8	31	83.8	34	97.1	85	96.6	300	98.4	0.001
Know/Suspect fentanyl in drugs – past 12 months	n = 460		n = 37		n = 34		n = 85		n = 304
No/Don’t Know	110	23.9	35	94.6	20	58.8	17	20.0	38	12.5
Yes	350	76.1	2	5.4	14	41.2	68	80.0	266	87.5	<.0001
Reason for knowing/Suspecting fentanyl in drugs	n = 251		n = 2		n = 9		n = 47		n = 193
Fentanyl test strip	7	2.8	0	0.0	0	0	1	2.1	6	3.1
Overdosed quickly	19	7.6	0	0.0	0	0	3	6.4	16	8.3
Someone else overdosed	12	4.8	0	0.0	1	11.1	3	6.4	8	4.1
Bought online as fentanyl	2	0.8	0	0.0	1	11.1	0	0.0	1	0.5
Dealer said so	55	21.9	0	0.0	2	22.2	9	19.1	44	22.8
Feel, color, taste	180	71.7	1	50.0	7	77.8	29	61.7	143	74.1
Another reason	49	19.5	1	50.0	2	22.2	13	27.7	33	17.1
Tested positive for it during mandatory urine drug testing	20	8.0	0	0.0	1	50	4	30.8	15	7.8
It is in everything/fentanyl saturation in local drug supply	20	8.0	1	100.0	1	50	3	23.1	15	100.0
Word of mouth	5	2.0	0	0.0	0	0	3	23.1	2	13.3
Another reason*	4	1.6	0	0.0	0	0	2	15.4	2	13.3
Looking to intentionally buy fentanyl	n = 284		n = 2		n = 11		n = 50		n = 220
Yes	75	26.4	0	0.0	2	18.2	15	30.0	58	26.4
No	209	73.6	2	66.7	10	90.9	35	70.0	162	73.6	0.01
Intended to buy…**	n = 172		n = 2		n = 8		n = 22		n = 140
Heroin	153	89.0	0	0.0	5	62.5	21	95.5	127	90.7
Powdered cocaine	7	4.1	1	50.0	1	12.5	0	0.0	5	3.6
Crack cocaine	5	2.9	0	0.0	0	0	1	4.5	4	2.9	0.003
Something else	7	4.1	1	50.0	2	25	0	0.0	4	2.9
Know how to recognize an overdose Number of overdose experiences	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Personal (n = 410): IQR: 4	3.61	8.6	0.42	0.9	1.66	2.61	3.79	8.7	4.22	9.4	2.66 (df = 3) 0.05
Witnessed (n = 462): IQR: 13	12.92	20.4	10.41	23.5	10.4	17.25	9.43	16.2	14.55	21.4	1.87 (df = 3) 0.13
Ever witnessed an overdose	N	%	N	%	N	%	N	%	N	%
No	47	10.2	8	21.6	2	5.7	8	9.1	29	9.6	0.14
Yes	415	89.8	29	78.4	33	94.3	80	90.9	273	90.4
Ever overdosed											32.8 (df = 3)
No	172	37.0	29	78.4	16	45.7	32	36.4	95	31.1
Yes	293	63.0	8	21.6	19	54.3	56	63.6	210	68.9	<.0001
Suspect fentanyl involved in last overdose	n = 236		n = 11		n = 13		n = 52		n = 163
No	57	24.2	5	62.5	7	53.8	11	21.2	34	20.9
Yes	179	75.8	3	37.5	6	46.2	41	78.8	129	79.1	0.004
Reason for suspecting fentanyl involved in last overdose	n = 179		n = 3		n = 6		n = 41		n = 129
Overdosed quickly	65	36.3	2	66.7	4	66.7	15	36.6	46	35.7
Feel, color, taste	77	43.0	1	33.3	2	33.3	16	39.0	59	45.7
Fentanyl test strip	2	1.1	0	0.0	0	0	1	2.4	1	0.8
Someone else overdosed quickly	4	2.2	0	0.0	0	0	0	0.0	4	3.1
Dealer said so	16	8.9	0	0.0	0	0	4	9.8	12	9.3
Another reason	61	34.1	0	0.0	2	33.3	14	34.1	45	34.9
Looking to buy fentanyl	4	2.2	0	0.0	0	0	1	7.1	3	6.7
Tested positive for it during mandatory urine drug testing	14	7.8	0	0.0	0	0	6	42.9	8	17.8
It is in everything/fentanyl saturation in local drug supply	11	6.1	0	0.0	0	0	3	21.4	8	17.8
Word of mouth	3	1.7	0	0.0	0	0	1	7.1	2	4.4
Small amount	6	3.4	0	0.0	1	50	0	0.0	5	11.1
Another reason***	23	12.8	0	0.0	1	50	3	21.4	19	42.2
Prepared to respond to an overdose
Naloxone awareness
No	13	2.8	3	8.1	2	5.7	1	1.1	7	2.3
Yes	452	97.2	34	91.9	33	94.3	87	98.9	298	97.7	0.08
Have personal naloxone kit
No	174	37.4	28	75.7	19	54.3	39	44.3	88	28.9	38.7 (df = 3)
Yes	291	62.6	9	24.3	16	45.7	49	55.7	217	71.1	<.0001
Trained in naloxone
No	118	25.4	21	56.8	12	34.3	24	27.3	61	20.0	25.5 (df = 3)
Yes	347	74.6	16	43.2	23	65.7	64	72.7	244	80.0	<.0001
Who trained to use naloxone	n = 284		n = 15		n = 15		n = 57		n = 197
Community organization	93	19.2	10	66.7	4	26.7	19	33.3	60	30.5	—
In treatment	85	17.6	1	6.7	2	13.3	16	28.1	66	33.5
Syringe services program	61	12.6	0	0.0	3	20	7	12.3	51	25.9
Doctor, pharmacist or another provider	47	9.7	1	6.7	4	26.7	15	26.3	27	13.7
Friend of family member	34	7.0	2	13.3	3	20	10	17.5	19	9.6
Self-taught	19	3.9	1	6.7	1	6.7	5	8.8	12	6.1
Jail	10	2.1	0	0.0	1	6.7	3	5.3	6	3.0
Another method****	22	4.5	2	13.3	1	6.7	6	10.5	13	6.6
911 Called – last witnessed overdose	n = 460		n = 36		n = 33		n = 88		n = 303
Don’t know	6	1.3	1	2.8	1	3.0	2	2.3	2	0.7
No	129	28.0	1	2.8	8	24.2	24	27.3	96	31.7	0.003
Yes	278	60.4	26	72.2	22	66.7	54	61.4	176	58.1
Never witnessed an overdose	47	10.2	8	22.2	2	6.1	8	9.1	29	9.6	—
Naloxone administered – last witnessed overdose	n = 417		n = 29		n = 33		n = 80		n = 275
No/Don’t know	83	19.9	9	31.0	9	27.3	18	22.5	47	17.1	5.08 (df = 3)
Yes	334	80.1	20	69.0	24	72.7	62	77.5	228	82.9	0.17
Personally administered	141	42.3	6	30.0	11	45.8	19	30.6	105	46.1	5.78 (df = 3)
Someone else administered	192	57.7	14	70.0	13	54.2	43	69.4	123	53.9	0.12

Note. Test-statistic is based on a chi-square test. Fisher’s exact tests were used when cell count was <5; only p-values are reported for Fisher’s Exact. DF: degrees of freedom. Bolded p-value = significant at p < 0.05.

^*Other reasons for suspected fentanyl in drug supply: amount; prior experience with dealer; saw other people’s response to the drug.

^**Not assessed in Lowell, Quincy, and Cape Cod.

^***Other reason for suspected fentanyl involvement in last overdose: not sure: used a lot; non-regular dealer; never overdosed on heroin before; shouldn’t have gone out; overdosed, must be fentanyl; didn’t buy from regular dealer; took many narcan kits to come back; watching reactions of other people who used.

^****Other ways that people were naloxone trained included: shelter; health department; trained at scene; job training; housing site; research study; police; not specified.