Abstract
BACKGROUND: The unintentional consumption of stimulants containing fentanyl among people who intend to only use stimulants contributes to overdose mortality in North America. Research exploring how fentanyl appears in the stimulant supply among people who manufacture and/or distribute drugs (PWDD) is critical to understanding supply-side factors that shape stimulant and opioid-involved overdose risk. METHODS: From April to July 2023, thirty PWDD incarcerated at the Rhode Island Department of Corrections completed an in-depth interview about stimulant and opioid-involved overdose. Data were thematically analyzed to explore speculated pathways through which fentanyl may appear in stimulants. RESULTS: Participants primarily endorsed unintentional fentanyl contamination pathways, including the accidental mix-up of drugs that look alike and cross-contamination via surfaces containing residual fentanyl where stimulant product is packaged. Congruent with historically contested beliefs about drug cutting and adulteration to induce dependence, some participants speculated that fentanyl may be intentionally added to stimulants to induce fentanyl dependence among people intending to only use stimulants to increase profits, though no participant reported firsthand knowledge of this. Participants extensively familiar with opioid and stimulant drug markets believed intentional contamination at high-level drug trafficking organizations was unlikely to occur as this would mix the drug markets, harming the profitability of maintaining distinct opioid and stimulant markets. CONCLUSION: Our findings challenge beliefs about the intentional addition of fentanyl in stimulants, showing them to be unsubstantiated. Instead, participants with advanced knowledge of drug manufacturing and distribution reported that fentanyl primarily appears in the stimulant supply unintentionally underscoring the need for targeted strategies to reduce contamination.