Substance Use
Associations of Fentanyl Polysubstance Use Patterns with Hepatitis C Virus and Skin and Soft Tissue Infections Among People Who Inject Drugs in New York City Mehrdad Khezri* Mehrdad Khezri Sarah Kimball Chenziheng Allen Weng Courtney McKnight Don Des Jarlais
Background: Fentanyl’s euphoric effects and short half-life may increase infectious disease transmission risks through frequent injecting and syringe sharing. We assessed whether fentanyl use and polysubstance use (PSU) patterns are associated with hepatitis C virus (HCV) antibody seropositivity and skin and soft tissue infections (SSTIs) among people who inject drugs (PWID) in New York City.
Methods: PWID, recruited using a modified respondent-driven sampling approach from October 2021 and July 2024, were tested for HCV and underwent urine toxicology screenings using the Premier Biotech 13-panel BioCup. Separate multivariable logistic regression models assessed the associations of fentanyl PSU patterns with HCV and SSTIs, adjusting for potential confounders.
Results: Of 502 PWID, the mean age was 48.6 years, and 74.4% were men. The prevalence of HCV antibody seropositivity and SSTIs was 44.6% and 10.4%, respectively. Fentanyl was detected in 82.5% of the sample. The most common fentanyl PSU combinations were with methadone (66.9%), opiates (65.9%), cocaine (64.9%), cannabis (44.8%), heroin (35.1%), benzodiazepines (32.1%), and alcohol (28.9%). Of 119 tested for xylazine, 36.1% co-used fentanyl and xylazine. Fentanyl use was significantly associated with increased odds of HCV seropositivity (aOR 2.28, 95%CI 1.32-4.04). Co-use of fentanyl with cocaine (aOR 2.71, 1.78-4.17), benzodiazepines (aOR 1.82, 1.18-2.81), and alcohol (aOR 2.01, 1.31-3.11) was also associated with HCV seropositivity. Co-use of fentanyl with cocaine (aOR 2.07, 1.03-4.55) and xylazine (aOR 4.57, 1.49-15.5) was associated with SSTIs.
Conclusions: Fentanyl use was associated with HCV and SSTIs. When combined with other psychoactive substances, fentanyl PSU may destabilize PWID and increase the risk for multiple infectious diseases, highlighting the need for tailored medication dosing for opioid use disorder and expanding access to syringe service programs and medical care for PWID in the fentanyl era.