Exploring the Psychological Side of Fentanyl: A Scoping Review to Disclose the Psychosocial Dimensions of Illicitly Manufactured Fentanyl Users
Background
Fentanyl is a powerful opioid. The abuse and overdoses related to Illicitly Manufactured Fentanyl (IMF) have become more prevalent. The majority of clinical studies on fentanyl have focused on its medical and biological aspects, particularly its addictive properties. Few studies have delved into the psychological aspects of illicit fentanyl use, and there is currently no comprehensive review providing a structured psycho-social profile of the population groups most vulnerable to its effects. The goal of this Scoping Review was to construct a psychological and social profile of individuals at risk of using illicit fentanyl. This profile will serve as a guiding force for shaping behavioral policies and public health prevention efforts necessary to face the recent pandemic.
Methods
Following the PRISMA guidelines we conducted a Scoping Review focused on the following research question: What are the practical psycho-social implications of illicit fentanyl use in the global population?
Results
The bibliographic research was carried out in the databases of Medline, Scopus, and PsycNet. The articles resulting from the research phase in the databases listed above produced a total of 17737 reports. After the screening process, 10 studies were included in the scoping review.
Discussion and Conclusion
This scoping review was the first to consistently and systematically outline the psychosocial implications of fentanyl dependence. Users of IMF are consistently younger than other drug users. People using fentanyl have a relatively low perception of risk. On the psycho-social levels, there is a significant correlation between fentanyl use and mental disorders such as suicidal thoughts, anxiety disorders, and depression. The development of psychotherapy, along with digital tools such as apps and online platforms, can be an initial step in addressing this challenge.
1. Kuczyńska K, Grzonkowski P, Kacprzak Ł, Zawilska JB. Abuse of fentanyl: An emerging problem to face. Forensic Sci Int. 2018;289:207-214. doi:10.1016/j.forsciint.2018.05.042
2. Ni L et al. Evaluating Drug Interactions between Ritonavir and Opioid Analgesics: Implications from Physiologically Based Pharmacokinetic Simulation. Pharmaceuticals. 2024;17(5):640. doi:10.3390/ph17050640
3. Vardanyan RS, Hruby VJ. Fentanyl-related compounds and derivatives: current status and future prospects for pharmaceutical applications. Future Med Chem. 2014;6(4):385-412. doi:10.4155/fmc.13.215
4. Volpe DA, McMahon Tobin GA, Mellon RD, et al. Uniform assessment and ranking of opioid µ receptor binding constants for selected opioid drugs. Regul Toxicol Pharmacol. 2011;59(3):385-390. doi:10.1016/j.yrtph.2010.12.007
5. Han Y, Cao L, Yuan K, Shi J, Yan W, Lu L. Unique Pharmacology, Brain Dysfunction, and Therapeutic Advancements for Fentanyl Misuse and Abuse. Neurosci Bull. 2022;38(11):1365-1382. doi:10.1007/s12264-022-00872-3
6. Comer SD, Cahill CM. Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neurosci Biobehav Rev. 2019;106:49-57. doi:10.1016/j.neubiorev.2018.12.005
7. Gibney E, Petrić Howe N. Fentanyl addiction: the brain pathways behind the opioid crisis. Nature. Published online May 2024. doi:10.1038/d41586-024-01541-3
8. Giorgetti A, Centola C, Giorgetti R. Fentanyl novel derivative-related deaths. Hum Psychopharmacol. 2017;32(3). doi:10.1002/hup.2605
9. Han Y, Yan W, Zheng Y, Khan MZ, Yuan K, Lu L. The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies. Transl Psychiatry. 2019;9(1):282. doi:10.1038/s41398-019-0625-0
10. World Health Organization. Opioid Overdose. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
11. Chandra DK, Altice FL, Copenhaver MM, Zhou X, Didomizio E, Shrestha R. Purposeful Fentanyl Use and Associated Factors among Opioid-Dependent People Who Inject Drugs. Subst Use Misuse. 2021;56(7):979-987. doi:10.1080/10826084.2021.1901931
12. D’Orazio J, Nelson L, Perrone J, Wightman R, Haroz R. Xylazine Adulteration of the Heroin–Fentanyl Drug Supply: A Narrative Review. Ann Intern Med. 2023;176(10):1370-1376. doi:10.7326/M23-2001
13. Reed MK, Imperato NS, Bowles JM, Salcedo VJ, Guth A, Rising KL. Perspectives of people in Philadelphia who use fentanyl/heroin adulterated with the animal tranquilizer xylazine; Making a case for xylazine test strips. Drug Alcohol Depend Rep. 2022;30(4):100074. doi:10.1016/j.dadr.2022.100074
14. Cárdenas-Quesada J, Torrens M, Farré M. Fentanyl and its derivatives, xylazine, and benzodiazepines: new sources of risk for acute poisonings. Emergencias. Published online May 2024. doi:10.55633/s3me/E036.2023
15. Hayashi K, Milloy MJ, Lysyshyn M, et al. Substance use patterns associated with recent exposure to fentanyl among people who inject drugs in Vancouver, Canada: A cross-sectional urine toxicology screening study. Drug Alcohol Depend. 2018;183:1-6. doi:10.1016/j.drugalcdep.2017.10.020
16. Kenney SR, Anderson BJ, Conti MT, Bailey GL, Stein MD. Expected and actual fentanyl exposure among persons seeking opioid withdrawal management. J Subst Abuse Treat. 2018;86:65-69. doi:10.1016/j.jsat.2018.01.005
17. Hochstatter KR et al. Characteristics and correlates of fentanyl preferences among people with opioid use disorder. Drug Alcohol Depend. 2022;240(17):109630. doi:10.1016/j.drugalcdep.2022.109630
18. Solis E, Cameron-Burr KT, Shaham Y, Kiyatkin EA. Fentanyl-Induced Brain Hypoxia Triggers Brain Hyperglycemia and Biphasic Changes in Brain Temperature. Neuropsychopharmacology. 2018;43(4):810-819. doi:10.1038/npp.2017.181
19. Tsang VWL et al. Systematic review on intentional non-medical fentanyl use among people who use drugs. Front Psychiatry. 2024;15:1347678. doi:10.3389/fpsyt.2024.1347678
20. Kranke P, Eberhart LH, Roewer N, Tramèr MR. Pharmacological Treatment of Postoperative Shivering: A Quantitative Systematic Review of Randomized Controlled Trials: Anesth Analg. 2002;94(2):453-460. doi:10.1097/00000539-200202000-00043
21. Kim N, Park JH, Lee JS, Choi T, Kim M. Effects of intravenous fentanyl around the end of surgery on emergence agitation in children: Systematic review and meta-analysis. Pediatr Anesth. 2017;27(9):885-892. doi:10.1111/pan.13181
22. Song L, Tan S, Chen Q, Li H. Effect of Fentanyl as an Adjuvant to Brachial Plexus Block for Upper Extremity Surgeries: A Systematic Review and Meta-Analysis of RCTs. Pain Res Manag. 2022;2022:1-13. doi:10.1155/2022/8704569
23. Tricco AC et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850
24. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi:10.1136/bmj.l4898
25. Higgins JPT, Morgan RL, Rooney AA, et al. A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E). Environ Int. 2024;186:108602. doi:10.1016/j.envint.2024.108602
26. Hong QN, Pluye P, Fàbregues S, et al. Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study. J Clin Epidemiol. 2019;111:49-59.e1. doi:10.1016/j.jclinepi.2019.03.008
27. Souto RQ, Khanassov V, Hong QN, Bush PL, Vedel I, Pluye P. Systematic mixed studies reviews: updating results on the reliability and efficiency of the Mixed Methods Appraisal Tool. Int J Nurs Stud. 2015;52(1):500-501. doi:10.1016/j.ijnurstu.2014.08.010
28. Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc. 2015;13(3):179-187. doi:10.1097/XEB.0000000000000062
29. Morales KB, Park JN, Glick JL, Rouhani S, Green TC, Sherman SG. Preference for drugs containing fentanyl from a cross-sectional survey of people who use illicit opioids in three United States cities. Drug Alcohol Depend. 2019;204:107547. doi:10.1016/j.drugalcdep.2019.107547
30. Gunn CM et al. Age-based preferences for risk communication in the fentanyl era: 'A lot of people keep seeing other people die and that's not enough for them.’ Addiction. 2021;116(6):1495-1504. doi:10.1111/add.15305
31. Kasson E et al. Using Social Media to Examine Themes Surrounding Fentanyl Misuse and Risk Indicators. Subst Use Misuse. 2023;58(7):920-929. doi:10.1080/10826084.2023.2196574
32. Volkow ND, Jones EB, Einstein EB, Wargo EM. Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA Psychiatry. 2019;76(2):208-216. doi:10.1001/jamapsychiatry.2018.3126
33. Brar R et al. Changes in drug use behaviors coinciding with the emergence of illicit fentanyl among people who use drugs in Vancouver, Canada. Am J Drug Alcohol Abuse. 2020;46(5):625-631. doi:10.1080/00952990.2020.1771721
34. McKnight C, Des Jarlais DC. Being ‘hooked up’ during a sharp increase in the availability of illicitly manufactured fentanyl: Adaptations of drug using practices among people who use drugs (PWUD) in New York City. Int J Drug Policy. 2018;60:82-88. doi:10.1016/j.drugpo.2018.08.004
35. Harris MTH et al. Competing risks of women and men who use fentanyl: ‘The number one thing I worry about would be my safety and number two would be overdose.’ J Subst Abuse Treat. 2021;125:108313. doi:10.1016/j.jsat.2021.108313
36. Connery HS et al. Suicidal motivations reported by opioid overdose survivors: A cross-sectional study of adults with opioid use disorder. Drug Alcohol Depend. 2019;205:107612. doi:10.1016/j.drugalcdep.2019.107612
37. Macmadu A et al. Drug use behaviors, trauma, and emotional affect following the overdose of a social network member: A qualitative investigation. Int J Drug Policy. 2022;107:103792. doi:10.1016/j.drugpo.2022.103792
38. He Y et al. Effectiveness of a Mindfulness Meditation App Based on an Electroencephalography-Based Brain-Computer Interface in Radiofrequency Catheter Ablation for Patients With Atrial Fibrillation: Pilot Randomized Controlled Trial. JMIR MHealth UHealth. 2023;11:e44855. doi:10.2196/44855
39. Chudnofsky CR, Wright SW, Dronen SC, Borron SW, Wright MB. The safety of fentanyl use in the emergency department. Ann Emerg Med. 1989;18(6):635-639. doi:10.1016/S0196-0644(89)80517-7