Exploring socioecological factors associated with fentanyl use among individuals

Theoretical Background and research questions/hypothesis: The impact of the opioid crisis on our communities has been severe. States have implemented various strategies, including prevention, treatment, and harm reduction approaches, to address the crisis. However, it is essential to identify the multifaceted factors that are impeding the effective management of this issue. Socio-ecological model (SEM) is a health promotion framework that can help understand the opioid crisis and develop effective strategies to prevent and address addiction. The model acknowledges individuals are embedded within a larger system, recognizing that behavior and health are influenced not only by individual characteristics but also the social factors and the environment. Thus, this study attempts to examine and understand the complex interplay of these factors among individuals who use or have used fentanyl and suggest strategies that may help prevent fentanyl addiction.

Methods: A qualitative analysis was used to help identify the most salient individual, interpersonal, community, and societal factors to interpret how they contributed to the continued use of drugs leading to fentanyl use. This study used publicly available 20 interviews (male =10 and female =10) conducted with individuals who are or who had used fentanyl. Interviews range between 25 to 45 minutes. Analysis of the interviews was conducted by using inductive analysis to describe and interpret information by using the SEM as a framework. Transcripts were obtained from the videos. Data were first coded into categories and then divided into code (matrix of SEM).

Results: Participants described a number of factors that influenced their use of the illicit drug, fentanyl. Individual factors identified included childhood trauma (e.g., being at gunpoint when trying to help someone, rape), personal health issues (e.g., seizures, depression), coping mechanisms (e.g., humor). Interpersonal factors included the family history of addiction (e.g., alcohol and drug use by parents), abuse by family members and employers (e.g., sexual molestation and verbal abuse), and fear (e.g., feeling of being a burden). Further, the community factors included easy access to illegal drugs (e.g., through youth gangs), bully (e.g., being called hyperactive, stupid by friends and teachers), labeling (e.g., such as addicts, druggists). Societal factors included stigma (e.g., negative outlook of the society), and mistreatment in prison (e.g., discrimination). Furthermore, findings revealed that most women using illicit drugs experience sexual abuse and rape in public spaces; however, one male mentioned that he was forced to be a male prostitute, and four males shared that they had been sexually molested and abused when they were minors. Individuals expressed strong emotional connection with family

Conclusions: Overall, the study highlighted the complex nature of individual life and described factors that impact their lives in continuing illicit drugs. However, the policy and structural factors were not identified.

Implications for research and/or practice: The study offers insight into multifaceted socio-ecological dynamics. Path to recovery strategies for individuals should utilize a collaborative and multi-sectoral approach that takes into account the intersecting determinants highlighted in this study.