Characteristics of adults reporting illicitly manufactured fentanyl or heroin use or prescription opioid misuse in the United States, 2019

Deaths involving illicitly manufactured fentanyl (IMF) have increased since 2013 in the United States. Little research has examined individuals using IMF. This study aims to explore the characteristics of US adults who used IMF, heroin, or misused prescription opioids and examine the associations between demographic, clinical, psychosocial characteristics and IMF use. A convenience sample of adults aged ≥ 18 years being assessed for substance use disorder (SUD) treatment was collected between January-December 2019 using the Addiction Severity Index-Multimedia Version instrument. We used a multivariable logistic regression model to examine the associations between demographic, clinical, psychosocial characteristics and IMF use. Adults reporting IMF as their primary lifetime substance use problem also reported using other substances—most often alcohol or heroin—both in the past 30 days and during their lifetime. Characteristics associated with increased odds of reporting IMF as the primary lifetime substance use problem included age 18–24 years (adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI) = 1.18–2.38) versus 45–54 years, non-Hispanic Black persons (aOR = 1.44; 95% CI = 1.11–1.85) versus non-Hispanic White persons, being assessed in Northeast (aOR = 15.46; 95% CI = 8.67–27.56) versus West, and having a history of at least one lifetime overdose (1 overdose (aOR = 1.91; 95% CI = 1.49–2.44); 2 overdoses (aOR = 1.95; 95% CI = 1.48–2.58); 3 or more overdoses (aOR = 2.27; 95% CI = 1.82–2.82)). These findings provide new insights into this high-risk population and help identify strategies to address increasing overdose death rates involving IMF. Opportunities for intervention include expanding naloxone distribution and harm reduction programs and connecting individuals with nonfatal overdoses to SUD treatment. •Individuals with a previous overdose were more likely to use illicit fentanyl.•Non-Hispanic Black persons were more likely to use illicit fentanyl.•Individuals assessed in the Northeast were more likely to use illicit fentanyl.•Medication for substance use disorder was associated with less illicit fentanyl use.•Attending self-help meetings was associated with less illicit fentanyl use.