Project Summary
Identifying context specific risks for individuals who inject heroin is central to overdose prevention and the control
of infectious diseases, given that the current opioid crisis is now characterized by a heroin supply contaminated
with synthetic opioids. While epidemiological patterns of risk are known from previous studies of heroin use, what
is not clear is how individual behaviors, strategies and local social and situational factors in the current synthetic
opioid/non-pharmaceutical fentanyl (NPF) crisis are promoting risk factors and/or self-protective behaviors in
distinct emerging fentanyl “hot spots”, such as Ohio. Informed by the Drug, Set, and Setting Framework with
concepts from the Symbiotic Model of Risk Reduction, this application will determine how social and
environmental determinants influence the relationship between heroin/NPF use trajectories, adverse health
outcomes, and risk or self-protective behaviors among individuals who inject heroin/NPF in Dayton, Ohio. Using
adaptive respondent driven sampling, 60 individuals reporting injecting heroin/NPF in the past month will be
recruited for qualitative life history interviews. The specific aims of the proposed study are: AIM 1: Provide an in-
depth qualitative description of how a rapidly changing heroin/NPF market (type/quality, availability) has
impacted injecting heroin/NPF use trajectories (initiation, drug switching, concurrent use) and adverse health
related drug risk behavior (overdoses, syringe sharing) in Dayton, Ohio; AIM 2: Examine individual-level
perceptions, preferences, and perceived effects regarding synthetic opioids, related strategies for the
identification of heroin adulterated with synthetic opioids, and current risk reduction practices among individuals
who inject heroin/NPF in Dayton, Ohio; AIM 3: Characterize qualitatively the influence of cultural and social
context on strategies, practices, and tactics for safer or riskier behaviors among individuals who inject
heroin/NPF in Dayton, Ohio. Proposed Principal Investigator, Tasha Perdue, is a PhD student leading an
interdisciplinary research team between faculty from USC and the Wright State University Center for
Interventions, Treatment, and Addictions Research. This highly productive collaborative interdisciplinary team is
well suited to accomplish the research goals. This research will have an important positive impact by identifying
pathways of individuals who are at the highest risk for developing harmful heroin/NPF use trajectories within this
distinct social context given the changes in availability of NPF and its analogues. In doing this, the project will
lay the foundation for the development and implementation of culturally appropriate targeted prevention and
treatment interventions that will reduce risk behaviors of heroin/NPF users that have gone underrepresented in
existing research.