(128) Perspectives from People Who Use Drugs: Experiences Using Fentanyl Containing BTMPS

Background & Introduction: Community Drug Checking Services (CDCS) are a harm reduction intervention that allows people who use drugs (PWUD) to identify the active components and adulterants in drug samples utilizing point-of-care Fourier-Transform Infrared Spectroscopy (FTIR) analysis (1,2). Through participant engagement with CDCS programs in King County, WA, a novel adulterant, Bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate (BTMPS), was identified in the non-pharmaceutical fentanyl (NPF) supply in June 2024. BTMPS, known as “boat glue” in the Greater Seattle Area, is a hindered amine UV light stabilizer used in plastics manufacturing and adhesives. Unlike other NPF adulterants observed across the United States, such as xylazine, BTMPS has no known psychoactive or therapeutic properties. While several published studies describe the epidemiology and public health surveillance of BTMPS emergence, no research to date has examined the physical sensations associated with using NPF containing BTMPS (NPF-BTMPS) or the perspectives of PWUD regarding its appearance in local supply (3,4).

Methods: To investigate the emergence of BTMPS and sensations associated with its use, along with other NPF adulterants, semi-structured interviews were conducted in February 2025 with 36 participants who had previously tested NPF through King County CDCS. Participants were compensated for their time with $50 gift cards. Interviews were recorded and manually transcribed. Transcripts were analyzed using qualitative data analysis software, Dedoose. Following the tenets of dynamic thematic analysis and adopting a framework established by Miles and Huberman (1994), the research team established a codebook and collaboratively identified cross-cutting themes from interview summaries, covering areas of concordance, discordance, and particular importance, as well as exemplar and negative cases. Researchers applied grounded theory methods to independently code interview transcripts and identify emergent themes.

Results: 33 of 36 participants reported using NPF suspected to be adulterated with BTMPS. Of these participants, 7 reported receiving FTIR results confirming the presence of BTMPS, 20 received negative FTIR results for BTMPS, and 6 participants indicated receiving neither negative nor positive FTIR results for BTMPS. Participant reports of BTMPS taste characteristics were particularly common and highly consistent, while reports of other sensory characteristics, such as appearance and smell, varied. Unlike other NPF adulterants, participants reported identifying BTMPS by taste alone rather than relying on FTIR results. Participants generally disliked BTMPS due to undesirable taste characteristics (n=27) and perceived lower NPF potency (n=13). No participants disclosed liking NPF-BTMPS, and all reports of NPF-BTMPS being desirable were secondhand. Among participants endorsing a negative experience using BTMPS (n=8), there were no clear associated adverse health effects reported at time of use. Participants also reported varied theories regarding the emergence and presence of NPF-BTMPS in the local supply (n=14).

Conclusion & Discussion: Participants shared insights gained through extended engagement with CDCS, and coding related to positive, negative, or suspected FTIR results for BTMPS was not clearly discrete. Findings illustrate that sentinel CDCS testing enabled PWUD to initially identify NPF-BTMPS. Subsequently, communities of PWUD detected BTMPS through shared sensory experiences communicated via social networks rather than through drug checking services alone. While CDCS data clearly reflect the sudden appearance of NPF-BTMPS, these data lack the nuanced perspective of PWUD. Incorporating the lived experiences of PWUD is essential for accurately understanding changes in the drug supply or the research will not reflect the full story.

References: 1. Giulini F, Keenan E, Killeen N, Ivers JH. A Systematized Review of Drug-checking and Related Considerations for Implementation as A Harm Reduction Intervention. J Psychoactive Drugs. 2023;55(1):85-93. doi:10.1080/02791072.2022.2028203
2. Moran L, Ondocsin J, Outram S, et al. How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives. Harm Reduct J. 2024;21(1):92. Published 2024 May 11. doi:10.1186/s12954-024-01014-w
3. Shover CL, Godvin ME, Appley M, et al. UV Stabilizer BTMPS in the Illicit Fentanyl Supply in 9 US Locations. JAMA. 2025;333(11):1000-1003. doi:10.1001/jama.2024.27550
4. Zhu DT, Krotulski AJ, Palamar JJ. The Rapid Spread of a Novel Adulterant in the US Illicit Drug Supply-BTMPS. JAMA Intern Med. 2025;185(9):1057-1058. doi:10.1001/jamainternmed.2025.2307