Impact of a Brief Fentanyl Educational Intervention on Demand for Cocaine mixed with Fentanyl

Individuals who use cocaine are at increased risk of overdose related to fentanyl in the cocaine supply, yet few interventions address fentanyl risks in people who use cocaine. Demand tasks use hypothetical decisions about drug purchases to quantify likely real-world behavior. My cocaine demand task, the Adulterated Cocaine Purchase 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. No previous studies have examined the impact of fentanyl education on cocaine demand. This pilot study tested the effects of a brief online fentanyl educational intervention on demand for cocaine mixed with fentanyl, fentanyl knowledge, and stated intentions to use harm reduction strategies when taking cocaine (e.g., using test strips, taking a tester dose, carrying naloxone). I hypothesized that participants in the fentanyl education intervention group would show stronger reductions in demand (intensity) for cocaine mixed with fentanyl relative to those in the control group, and secondarily, that they would show increased fentanyl knowledge, and increased intentions to use other harm reduction strategies when taking cocaine. 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 Purchase Task, self-reported fentanyl knowledge, and harm reduction strategies. Demographics and substance use history were also assessed. Findings suggested that providing brief fentanyl education significantly increased fentanyl knowledge. Results also indicated that 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 stronger reductions in demand for cocaine mixed with fentanyl relative to those in the control group. Results also showed that fentanyl education and harm reduction behaviors were not significantly related. Findings from this research study further suggest the urgent need to prioritize strategies aside from education to address overdose risk among people who use cocaine.