The emergence of fentanyl in a stimulant landscape - Un/intentional use, social relations, and developing communities of care

Sep 28, 2026

Background: The introduction of fentanyl into the unregulated drug supply has drastically altered drug landscapes across the United States and increasingly contributed to overdose. Methods: From 2022–2024, ethnographic fieldwork, surveys, and qualitative interviews assessed how fentanyl emergence shaped health outcomes and social relations in underserved California. Results: Among opioid users, exposure often began unintentional but shifted to intentional use. Conclusion: Findings support evidence-based fentanyl education, expanded harm reduction services, and low-barrier treatment to promote community care.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages25

Reading Time1 h 3 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Keywords

Author Manuscript Author Manuscript Author Manuscript Author Manuscript | | HHS Public Access
Author manuscript
Int J Drug Policy. Author manuscript; available in PMC 2026 January 02. | | --- | --- | Published in final edited form as: Int J Drug Policy. 2025 June ; 140: 104807. doi:10.1016/j.drugpo.2025.104807 . The emergence of fentanyl in a stimulant landscape: Un/ intentional use, social relations, and developing communities of care Jennifer Syvertsena,* , Alejandra Cabralb, Elijah Knaapc, Sergio Reyc, Robin A. Pollinida Department of Anthropology, University of California, Riverside, CA, USA b Department of Community Health Sciences, University of California, Los Angeles, CA, USAcCenter for Open Geographical Science, San Diego State University, CA, USA d Departments of Behavioral Medicine & Psychiatry and Epidemiology & Biostatistics, West Virginia University, Morgantown, WV, USA Abstract Background: The introduction offentanyl into the unregulated drug supply has drastically altered drug landscapes across the United States and increasingly contributed to overdose. As part of a larger study about opioid overdose, we assessed how the emergence offentanyl has shaped health outcomes and social relations in an underserved region of California. Methods: From 2022–2024, we engaged in ethnographic fieldwork, surveys, and qualitative interviews with people 18+ years old and reporting opioid or stimulant use in the prior three months. We generated descriptive statistics and examined un/intentional fentanyl use among people using opioids (regardless of stimulant use) compared to those exclusively using stimulants. Qualitative interviews were thematically coded to lend insight into the social contexts of fentanyluse. Results: Of 195 survey participants, 31 % were women, and 60 % identified as racialized groups, with an average age of 43; the qualitative sub-sample (n= 53 interviews) was similar. People using opioids were often initially unintentionally exposed to fentanyl through the heroin supply or prescription pills, but shifted to intentional use. People using stimulants attributed unintentional fentanyl use to adulterated methamphetamine, mistaking fentanyl for other drugs, and sharing smoking tools. Socially, fentanyl heightened overdose risk and fueled community stigma, while This is an open access article under the CC BY-NC-ND license ([https://creativecommons.org/licenses/by-nc-nd/4.0/](https://creativecommons.org/licenses/by-nc-nd/4.0/)). *Corresponding author at: 900 University Ave, Department of Anthropology, 1320B Watkins Hall, UCR, Riverside, CA, 92521, USA. [jsyverts@ucr.edu](jsyverts@ucr.edu) (J. Syvertsen). Declaration of competing interest All authors disclose that we do not have any financial and personal relationships with other people or organizations that could inappropriately influence or bias our work. CRediT authorship contribution statement Jennifer Syvertsen: Writing – review & editing, Writing – original draft, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Alejandra Cabral: Writing – review & editing, Investigation, Formal analysis, Data curation. Elijah Knaap: Writing – review & editing, Funding acquisition, Conceptualization. Sergio Rey: Writing – review & editing, Funding acquisition, Conceptualization. Robin A. Pollini: Writing – review & editing, Funding acquisition, Conceptualization. Author Manuscript Author Manuscript Author Manuscript Author Manuscript Syvertsen et al. Page 2 paradoxically instantiating forms of community care (i.e., overdose response, warning those experimenting with fentanyl) . Conclusion: Our research calls for evidence-based education about fentanyl, expanded access to harm reduction services, including community drug checking and safer smoking supplies, and low-barrier drug treatment as part of broader efforts to promote community care. Keywords

FAQs

What is the study investigating about fentanyl’s emergence?

The study examines how the emergence of fentanyl has shaped health outcomes and social relations, including intentional and unintentional fentanyl use, in an underserved region of California.

How were fentanyl-related behaviors and contexts studied?

Between 2022 and 2024, the study used ethnographic fieldwork, surveys, and qualitative interviews with adults (18+) reporting opioid or stimulant use in the prior three months, followed by descriptive statistics and thematic coding.

What outcomes and social effects did the researchers find?

People using opioids often shifted from initially unintentional fentanyl exposure to intentional use; stimulant users attributed unintentional fentanyl to adulterated methamphetamine and drug-mixing practices. Socially, fentanyl increased overdose risk and contributed to community stigma.

Sep 28, 2026

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