New research reveals alarming prevalence of unintentional fentanyl use

NEW YORK – New research finds that more than 80% of New Yorkers who inject drugs test positive for fentanyl, despite only 18% using it intentionally. The study was led by researchers at the NYU School of Global Public Health, who conducted hundreds of surveys and in-depth interviews with people who injected drugs in 2021 and 2022. The study participants also underwent drug testing for fentanyl, heroin, other opioids, and stimulants, so that researchers could compare toxicology results with self-reported drug use.

“The overwhelming majority of people in this study—regardless of the intentionality of recent fentanyl use—reported heroin as their main drug, indicating a strong preference for heroin over fentanyl. Yet, as our urine toxicology data indicate, people who inject drugs seem to have little agency in avoiding fentanyl,” said Courtney McKnight, clinical assistant professor of epidemiology at NYU School of Global Public Health and the study’s lead author.

The research is particularly concerning because of the potency of fentanyl. The synthetic opioid is 50 to 100 times more potent than morphine and is responsible for an increasing number of deaths throughout the United States. The Centers for Disease Control and Prevention reported a record nearly 110,000 overdose deaths in 2022. Fentanyl and other synthetic opioids remained the primary contributors to these deaths.

“As the proportion of drug overdose deaths involving fentanyl continues to increase, it’s important to monitor how often people are exposed to fentanyl and any changes in preference for fentanyl among people who use drugs,” said McKnight.

As far as study participants, almost one in four had overdosed at least once in the past six months. Those who intentionally used fentanyl were more likely to overdose. Researchers also found that people who inject drugs are building up a tolerance to fentanyl, which seems to be driving their preference for this more potent drug. Several interviewees reported that the potency of heroin has actually decreased for them, causing them to desire a stronger drug unintentionally.