Fentanyl Use Among People Who Inject Drugs in Two Large Pacific Northwest Metropolitan Areas.

Authors

Lauren Lipira, Portland State University
Sara N. Glick, Division of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
Courtney Moreno, HIV/STD Program, Public Health - Seattle & King County, 401 5th Ave, Seattle, WA, 98104, USA.
Lalaine Sevillano, Portland State University
Matthew A. Town, Portland State University
Timothy W. Menza, Division of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.

Published In

Harm Reduction Journal

Document Type

Pre-Print

Publication Date

3-12-2026

Abstract

Background

We examined fentanyl use and outcomes among people who inject drugs (PWID) in the urban Pacific Northwest (PNW).

Methods We conducted secondary analysis of data from the 2022 National HIV Behavioral Surveillance PWID cycle from Portland, OR and Seattle, WA. We calculated proportions of any fentanyl, injection fentanyl, non-injection fentanyl, and street pill use. Next, we compared characteristics, behaviors, and outcomes by any fentanyl use. Finally, we estimated adjusted relative risk (aRR) of overdose outcomes associated with fentanyl use and injecting less associated with type of street pill use.

Results

Among 835 PWID, 76% reported fentanyl use, 47% injection fentanyl use, 68% non-injection fentanyl use, and 66% street pill use. Of those who used pills, 94% smoked them. Fentanyl use was crudely associated with age; race; housing; detainment; usual drug injected; injection frequency; syringe service programs, substance treatment, overdose, and naloxone (p< 0.05). With adjustment, any fentanyl use (aRR=2.99, 95% CI: 1.55-5.76), injection fentanyl use (aRR=2.98, 95% CI: 1.43-6.19), and non-injection fentanyl use (aRR=2.12, 95% CI: 1.19-3.75) were associated with higher risk of overdose. Participants who smoked street pills were more likely to report injecting less because of pill use (aRR=1.80, 95% CI: 1.23-2.64).

Conclusions

Fentanyl use was highly prevalent among PWID in the urban PNW. Non-injection fentanyl use was most common and street pills were frequently administered by smoking which was associated with injecting less. All fentanyl use was associated with increased risk for overdose. There is ongoing need for access to naloxone for PWID who use fentanyl.

Rights

Copyright (c) 2026 The Authors

This work is licensed under a Creative Commons Attribution 4.0 International License.

DOI

10.1186/s12954-025-01384-9

Persistent Identifier

https://archives.pdx.edu/ds/psu/44581

Publisher

Springer Science and Business Media LLC

Citation Details

Lipira, L., Glick, S. N., Moreno, C., Sevillano, L., Town, M. A., & Menza, T. W. (2026). Fentanyl use among people who inject drugs in two large Pacific Northwest metropolitan areas. Harm Reduction Journal.