Theme: Social Science & Policy Research Year: 2024
Background: In 2022, Philadelphia, PA recorded its greatest number of overdose deaths (1,413). Most deaths involved fentanyl, but increasingly, these deaths involve stimulants (70%) and xylazine (34%), suggesting missed opportunities for harm reduction. Stimulant (without opioid) deaths increased 17% between 2021 and 2022 and the most pronounced increases occurred among non-White individuals (146% in non-Hispanic black and 81% in Hispanic individuals from 2018- 2022). We present development of services to reduce stimulant-related harms in Philadelphia.
Approach: We interviewed people in target groups and neighborhoods about stimulants to learn about use patterns, awareness of risks, and means to reduce harm. We developed outreach and education materials based on the responses. Feedback from target group members, obtained via focus groups and street-side interviews, was then used in iterative revisions and message prioritization.
Analysis: We discussed responses to consider meanings and recognize differences by social and neighborhood groups and by opioid use history. Generally, differences involved 1) which stimulants were used 2) terminology, 3) patterns of use (regular or occasional), 4) social aspects of use, 5) awareness of and concern about adulteration with opioids and xylazine, 6) knowledge of and concerns about risks of short- and long-term opioid and stimulant use, 7) interest in harm reduction actions, 8) reasons to avoid certain harm reduction recommendations, 9) rejection of harm reduction messages not tailored to their social or neighborhood groups, 9) trust in the source of information, and 10) preferred delivery methods.
Conclusion: Prevention of overdose from opioids present in stimulants is a priority for all, but many who use stimulants do not recognize their risk and resist being associated with people who use opioids. This and other social and community factors are addressed in our materials and must be addressed by harm reductionists for effective stimulant risk reduction.