Impact of a brief fentanyl educational intervention on demand for cocaine mixed with fentanyl

People who use cocaine are at increased risk of overdose related to fentanyl in the cocaine supply, yet few interventions address fentanyl risks among this population. Demand tasks use hypothetical decisions about drug purchases to quantify likely real-world behavior. Our cocaine demand task, the Adulterated Cocaine Purchasing Task, contrasts planned purchases of cocaine when there is 0 % probability (no chance) the cocaine is mixed with fentanyl vs. 10 % probability (in 10 chance) the cocaine is mixed with fentanyl.

Using a between-subjects design, participants who reported purchasing cocaine in the past year (N = 58) were randomly assigned to complete test measures either following (intervention group; n = 30) or before receiving (control group; n = 28) fentanyl education. Test measures consisted of the Adulterated Cocaine Purchasing Task, self-reported fentanyl knowledge, and harm reduction strategies. Demographics and substance use history were also assessed.

Findings suggested providing brief fentanyl education significantly increased fentanyl knowledge. Results also indicated higher probability (1 in 10 chance) of fentanyl admixture was consistently related to decreased cocaine demand across multiple demand indices (e.g., reducing their consumption when cocaine is free). However, providing brief education did not lead to reduced demand for cocaine mixed with fentanyl relative to those in the control group. Results also showed fentanyl education did not affect endorsement of harm reduction behaviors.

Our findings further suggest the urgent need to prioritize strategies aside from education to address overdose risk among people who use cocaine.