Theme: Epidemiology & Public Health Research Year: 2024
Background: Fentanyl presents challenges to the effectiveness of methadone and other agonist treatments due to its high potency and shorter half-life. This study examines experiences with methadone among people using fentanyl in New York City.
Methods: Between 2021-2024, N=462 PWID participated in a survey about drug use, overdose, and methadone; and urine toxicology (UT) screening. N=54 in-depth interviews (IDI) explored patterns of substance use, treatment, and overdose.
Results: UT results indicate fentanyl was the most common drug (86%), followed by cocaine (78%) and methadone (76%). Among participants in methadone maintenance treatment (MMT) (55%), 97% were methadone-positive, and 49% not enrolled in MMT were methadone-positive.
Participants reported increased use of fentanyl to avoid the effects of withdrawal. Among individuals on MMT, they commonly reported methadone was not able to stave off withdrawal long-term (With fentanyl, meth only lasts a couple hours, then I’m ill again”). The emergence of drugs like xylazine also impacted withdrawal (“The problem with tranq dope is you don’t have the same withdrawal as heroin or fentanyl”). Non-prescription methadone use was common among people in MMT (“If I go to work early, I’ll buy it because I can’t make it to the program”) and those not in MMT (“If I can’t find people I normally get drugs from, I’ll buy methadone because I don’t trust everybody”), and was often used as an overdose prevention strategy among participants (Recently I bought it so I wouldn’t have to do fent).
Conclusions: PWID face significant health risks because of the predominance of fentanyl, xylazine and other drugs in the unregulated drug supply. While PWID use methadone to reduce these risks, fentanyl and xylazine can limit its effectiveness, and structural factors impede accessibility. Findings suggest the need for increased access to methadone and implementation of novel forms of opioid maintenance treatment to reduce overdose risk.
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