Abstract

Background: Illicit fentanyl use by young adults has contributed to a significant increase in overdose drug deaths. Fentanyl has hit the drug use scene in the Northeast and Midwest, and has recently reached the West Coast and the Pacific Northwest, particularly Washington State. For this study, we explored the attitudes and beliefs of people who use drugs (PWUD) and changing drug use in Washington State and their response to fentanyl-involved overdose. We include recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl use. Methods: We conducted in-depth interviews with face-to-face sessions in September and October of 2024. We use thematic analysis to analyze transcripts and construct themes. Results: PWUD knew about fentanyl and expressed concern about other illicit drugs containing fentanyl or other opioids. They were not willing to talk to professionals due to fear of arrest or referral to treatment. Some PWUD recommended legalizing and regulating the drug supply and reducing the stigma of substance use. Conclusion: PWUD in Washington State were aware of the increase in fentanyl use and wanted access to easy tools to reduce the harm and the stigma of fentanyl use.