Leveraging barbershops for community-based addiction research: A pilot study using hair samples to detect fentanyl...

The ongoing opioid overdose crisis disproportionately affects minority communities, highlighting the urgent need for community-based addiction research to better understand and address this public health issue. Community-academic partnerships are a key strategy to engage these communities in addiction research. Here we describe the Health Advocates In-Reach and Research (HAIR) initiative, a collaboration between the University of Maryland and the National Institute on Drug Abuse Intramural Research Program. We tested whether barbershops, a trusted community venue, can support hair collection for fentanyl toxicology and a stress biomarker (cortisol) to inform equitable overdose prevention.

Within the HAIR initiative, community barbers/stylists and academic partners co-designed an anonymized, barbershop-based hair collection pilot project. Prespecified objectives were to (1) build trust between researchers and community members, (2) evaluate feasibility (successful collection and laboratory assay completion) and acceptability, (3) quantify fentanyl in hair, (4) quantify hair cortisol, and (5) explore associations between fentanyl detection and cortisol. Liquid chromatography-mass spectrometry (LC/MS) assays for quantitative analysis were developed and applied. Forty samples were collected from predominantly Black (85%), non-Hispanic (77.5%), male (95%) patrons.

Cortisol concentrations were successfully measured in 36 of the 40 samples, ranging from 3.36 to 104.00 pg/mg. Fentanyl was detected in 13 of the 40 samples, specifically four in quantifiable amounts (10.20-171.00 pg/mg) and nine samples containing trace amounts below the limit of quantification. An ordinary least squares regression model suggested that fentanyl presence may be predictive of increased cortisol after controlling for demographic variables. This association did not reach statistical significance (p = .065), likely due to limited statistical power from the small sample size.

This pilot study presents a promising community-based translational research model to advance addiction implementation science. Barbershops represent a feasible, acceptable setting for community-based hair toxicology and stress biomarker collection, enabling the identification of otherwise unrecognized exposure and stress signals within high-burden populations. This practice-ready workflow could augment local overdose strategies, linking on-site findings to naloxone distribution and rapid Medications for Opioid Use Disorder (MOUD) navigation, and merits evaluation in larger hybrid implementation science studies.