“You Never Know What You’re Getting”: Opioid Users’ Perceptions of Fentanyl in Southwest Pennsylvania

Katherine McLean, Shannon M. Monnat, Khary Rigg, Glenn E. Sterner, Ashton Verdery

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background: Urban areas in the United States have experienced a dramatic surge in fentanyl overdose deaths since 2014, a trend affecting both larger and smaller metropolitan areas. Encompassing only 1.2 million residents, Allegheny County, Pennsylvania, nevertheless saw 412 fentanyl-involved deaths in 2016, a number surpassed only by New York City and Cook County (Chicago), Illinois. Objectives: This article seeks to describe opioid users’ perceptions of fentanyl in Allegheny and three adjacent counties; it further considers how the drug’s emergence shapes some users’ market behaviors and consumption practices. Methods: This article reports on qualitative interview data (N = 30) collected as part of a larger, multi-phase, mixed methods study (N = 125) among individuals reporting past-year prescription opioid misuse or heroin use in four southwest Pennsylvania Counties. Results: Most interviewees reported past-year suspected exposure to fentanyl, and many reported suffering or seeing suspected fentanyl overdoses. Where roughly one-third reported strategies for avoiding fentanyl, a small group of interviewees identified advantages to fentanyl, while still acknowledging its associated risks. Conclusions/Importance: Given users’ diverse opinions around fentanyl, the distribution of fentanyl test strips may represent an effective response to the current crisis.

Original languageEnglish (US)
Pages (from-to)955-966
Number of pages12
JournalSubstance Use and Misuse
Issue number6
StatePublished - May 12 2019


  • Fentanyl
  • harm reduction
  • heroin
  • overdose
  • prescription opioids

ASJC Scopus subject areas

  • Health(social science)
  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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