{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T10:29:27Z","timestamp":1785493767898,"version":"3.56.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA046049-01A1S1"],"award-info":[{"award-number":["R01DA046049-01A1S1"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01-DA046049"],"award-info":[{"award-number":["R01-DA046049"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Institute for Addiction Science","award":["PG1033682"],"award-info":[{"award-number":["PG1033682"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec011\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Fentanyl is the leading cause of opioid-related overdose deaths in the United States. Given the exogenous market shock of fentanyl and subsequent transition in the illicit opioid supply, our analysis sought to explore the social and relational experiences of people who use opioids (PWUO).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec012\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted qualitative interviews with 30 PWUO (n\u2009=\u200930) in Los Angeles, CA from July 2021 to April 2022. To be eligible for this study, participants had to report being 18 years of age or older and any self-reported opioid, cannabis, and injection drug use within the past 30 days. We used constructivist grounded theory to analyze the contexts that contribute to lived experiences surrounding opioid use behaviors within social networks.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec013\">\n<jats:title>Results<\/jats:title>\n<jats:p>Within an unpredictable drug market contaminated by fentanyl, participants reported: 1) avoiding opioid withdrawal symptoms by sharing financial and material resources within social networks, 2) securing and cultivating known, predictable social ties to prioritize safe\/ safer supply of opioids, and 3) avoiding and mitigating risk of overdose fatality by using opioids within peer groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec014\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our findings emphasize that while peer support plays a critical role in safety within moral economies of PWUO, structural changes are needed to address the additional harms from an unregulated drug supply. Harm reduction interventions such as fentanyl test strip and naloxone distribution, as well as medication for opioid use disorders may improve safety. However, with a fentanyl-contaminated drug supply increasing risk for PWUO, safer opioid distribution of pharmaceutical-grade opioids and overdose prevention programs are needed to effectively address the burden of withdrawal, overdose, and fatality prevention within peer groups.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0320423","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T23:22:20Z","timestamp":1743636140000},"page":"e0320423","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["\u201cYou take care of people, people will take care of you\u201d: Moral Economies and an Unpredictable Drug Market"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6778-614X","authenticated-orcid":true,"given":"Erin E.","family":"Gould","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4330-180X","authenticated-orcid":true,"given":"Siddhi S.","family":"Ganesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J.","family":"DiMario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimi","family":"Huh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3491-1702","authenticated-orcid":true,"given":"Ricky N.","family":"Bluthenthal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel Carmen","family":"Ceasar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"issue":"4","key":"pone.0320423.ref001","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/YCO.0000000000000717","article-title":"The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis","volume":"34","author":"D Ciccarone","year":"2021","journal-title":"Curr Opin Psychiatry"},{"key":"pone.0320423.ref002","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.drugalcdep.2016.11.033","article-title":"A review: Fentanyl and non-pharmaceutical fentanyls","volume":"171","author":"J Suzuki","year":"2017","journal-title":"Drug Alcohol Depend"},{"key":"pone.0320423.ref003","doi-asserted-by":"crossref","first-page":"107515","DOI":"10.1016\/j.drugalcdep.2019.06.017","article-title":"Fentanyl exposure and preferences among individuals starting treatment for opioid use disorder","volume":"204","author":"J Gryczynski","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"6","key":"pone.0320423.ref004","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1080\/10826084.2024.2306221","article-title":"Characterizing opioid withdrawal experiences and consequences among a community sample of people who use opioids","volume":"59","author":"KA Simpson","year":"2024","journal-title":"Subst Use Misuse"},{"issue":"1","key":"pone.0320423.ref005","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s12954-023-00863-1","article-title":"\u201cJust another thing for me to stress off of\u201d: Responses to unintentional fentanyl use in a community-based study of people who use opioids","volume":"20","author":"J Lorvick","year":"2023","journal-title":"Harm Reduct J"},{"issue":"2","key":"pone.0320423.ref006","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1037\/adb0000834","article-title":"Fentanyl overdose concerns among people who inject drugs: The role of sex, racial minority status, and overdose prevention efforts","volume":"37","author":"AA Jones","year":"2023","journal-title":"Psychol Addict Behav"},{"issue":"1","key":"pone.0320423.ref007","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1146\/annurev-soc-071312-145554","article-title":"Drugs, violence, and the state","volume":"39","author":"BR Roberts","year":"2013","journal-title":"Annu Rev Sociol"},{"key":"pone.0320423.ref008","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.drugpo.2017.06.005","article-title":"Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic","volume":"46","author":"N Fairbairn","year":"2017","journal-title":"Int J Drug Policy"},{"issue":"23","key":"pone.0320423.ref009","first-page":"631","article-title":"Opioid overdose prevention programs providing naloxone to laypersons - United States, 2014","volume":"64","author":"Centers for Disease Control and Prevention","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"pone.0320423.ref010","first-page":"54","article-title":"Experiences of people who use drugs with naloxone administration: A qualitative study","volume":"29","author":"E Rochester","year":"2020","journal-title":"Drugs: Educ Prev Policy"},{"issue":"2","key":"pone.0320423.ref011","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1080\/00380253.2024.2306979","article-title":"Fronts and friends: Social contingencies in the management of drug debt","volume":"65","author":"A Laing","year":"2024","journal-title":"Sociol Q"},{"key":"pone.0320423.ref012","volume-title":"Righteous dopefiend","author":"PI Bourgois","year":"2009"},{"issue":"1","key":"pone.0320423.ref013","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/past\/50.1.76","article-title":"The moral economy of the english crowd in the eighteenth century","volume":"50","author":"EP Thompson","year":"1971","journal-title":"Past Present"},{"issue":"1","key":"pone.0320423.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/674613","article-title":"The moral economy of violence in the US inner city","volume":"55","author":"G Karandinos","year":"2014","journal-title":"Curr Anthropol"},{"issue":"4","key":"pone.0320423.ref015","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1177\/1463499616678097","article-title":"Moral economy: Rethinking a radical concept","volume":"16","author":"J Palomera","year":"2016","journal-title":"Anthr Theory"},{"issue":"1","key":"pone.0320423.ref016","first-page":"79","article-title":"Moral economy and political economy","volume":"61","author":"A Sayer","year":"2000","journal-title":"Stud Polit Econ"},{"key":"pone.0320423.ref017","article-title":"The moral economy of the peasant: Rebellion and subsistence in Southeast Asia","author":"JC Scott","year":"1977"},{"issue":"11","key":"pone.0320423.ref018","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.3109\/10826089809056260","article-title":"The moral economies of homeless heroin addicts: confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments","volume":"33","author":"P Bourgois","year":"1998","journal-title":"Subst Use Misuse"},{"issue":"4","key":"pone.0320423.ref019","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00127-021-02199-2","article-title":"Mental disorder and opioid overdose: A systematic review","volume":"57","author":"J van Draanen","year":"2022","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"pone.0320423.ref020","doi-asserted-by":"crossref","first-page":"100257","DOI":"10.1016\/j.dadr.2024.100257","article-title":"\u201cSmoking weed it gets you over the hump\u201d: Cannabis co-use as a facilitator of decreased opioid use among people who inject drugs in Los Angeles, California","volume":"12","author":"SS Ganesh","year":"2024","journal-title":"Drug Alcohol Depend Rep"},{"key":"pone.0320423.ref021","volume-title":"Constructing grounded theory","author":"K Charmaz","year":"2014"},{"issue":"1","key":"pone.0320423.ref022","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1108\/QRJ-07-2019-0059","article-title":"A practical example of using theoretical sampling throughout a grounded theory study: A methodological paper","volume":"20","author":"T Ligita","year":"2019","journal-title":"QRJ"},{"issue":"3","key":"pone.0320423.ref023","article-title":"The power and potential of grounded theory","volume":"6","author":"K Charmaz","year":"2012","journal-title":"Med Sociol Online"},{"key":"pone.0320423.ref024","article-title":"ATLAS.ti. Mac version 23.2.1 [software]","author":"ATLAS.ti Scientific Software Development","year":"2023"},{"issue":"1","key":"pone.0320423.ref025","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1186\/s12954-023-00893-9","article-title":"\u201cAs safe as possible\u201d: A qualitative study of opioid withdrawal and risk behavior among people who use illegal opioids","volume":"20","author":"D Frank","year":"2023","journal-title":"Harm Reduct J"},{"key":"pone.0320423.ref026","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jsat.2018.01.005","article-title":"Expected and actual fentanyl exposure among persons seeking opioid withdrawal management","volume":"86","author":"SR Kenney","year":"2018","journal-title":"J Subst Abuse Treat"},{"issue":"1","key":"pone.0320423.ref027","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.drugpo.2013.07.003","article-title":"\u201cI felt like a superhero\u201d: The experience of responding to drug overdose among individuals trained in overdose prevention","volume":"25","author":"KD Wagner","year":"2014","journal-title":"Int J Drug Policy"},{"key":"pone.0320423.ref028","doi-asserted-by":"crossref","first-page":"113190","DOI":"10.1016\/j.socscimed.2020.113190","article-title":"\u201cGenerally, you get 86\u2019ed because you\u2019re a liability\u201d: An application of integrated threat theory to frequently witnessed overdoses and social distancing responses","volume":"260","author":"JM Bowles","year":"2020","journal-title":"Soc Sci Med"},{"key":"pone.0320423.ref029","volume-title":"Kicking the Habit: The Opioid Crisis and America\u2019s Addiction to Prohibition. Cato Institute; 2020 June 29","author":"J Bowers","year":"2020"},{"issue":"3","key":"pone.0320423.ref030","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1177\/0033354920915439","article-title":"Knowledge of Good Samaritan laws and beliefs about arrests among persons who inject drugs a year after policy change in Baltimore, Maryland","volume":"135","author":"KE Schneider","year":"2020","journal-title":"Public Health Rep"},{"key":"pone.0320423.ref031","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.drugpo.2017.06.008","article-title":"Why are some people who have received overdose education and naloxone reticent to call emergency medical services in the event of overdose?","volume":"48","author":"S Koester","year":"2017","journal-title":"Int J Drug Policy"},{"key":"pone.0320423.ref032","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.drugpo.2017.09.010","article-title":"\u201cCaught with a body\u201d yet protected by law? Calling 911 for opioid overdose in the context of the Good Samaritan Law","volume":"50","author":"AD Latimore","year":"2017","journal-title":"Int J Drug Policy"},{"issue":"1","key":"pone.0320423.ref033","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s40352-022-00172-y","article-title":"Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone","volume":"10","author":"HM Smiley-McDonald","year":"2022","journal-title":"Health Justice"},{"issue":"3","key":"pone.0320423.ref034","doi-asserted-by":"crossref","first-page":"671","DOI":"10.5811\/westjem.2019.12.45189","article-title":"Variations in the California emergency medical services response to opioid use disorder","volume":"21","author":"NK Glober","year":"2020","journal-title":"West J Emerg Med"},{"issue":"3","key":"pone.0320423.ref035","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.drugpo.2009.01.003","article-title":"Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA","volume":"21","author":"KD Wagner","year":"2010","journal-title":"Int J Drug Policy"},{"issue":"22","key":"pone.0320423.ref036","doi-asserted-by":"crossref","first-page":"12073","DOI":"10.3390\/ijerph182212073","article-title":"Peer support and overdose prevention responses: A systematic \u201cState-of-the-Art\u201d review","volume":"18","author":"F Mercer","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0320423.ref037","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.socscimed.2019.02.014","article-title":"Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada","volume":"225","author":"MC Kennedy","year":"2019","journal-title":"Soc Sci Med"},{"key":"pone.0320423.ref038","doi-asserted-by":"crossref","first-page":"100263","DOI":"10.1016\/j.dadr.2024.100263","article-title":"Quality of participants\u2019 relationships to peer recovery support specialists as a function of perceived similarities: An exploratory analysis","volume":"12","author":"M Tillson","year":"2024","journal-title":"Drug Alcohol Depend Rep"},{"key":"pone.0320423.ref039","doi-asserted-by":"crossref","first-page":"102769","DOI":"10.1016\/j.drugpo.2020.102769","article-title":"Tackling the overdose crisis: The role of safe supply","volume":"80","author":"A Ivsins","year":"2020","journal-title":"Int J Drug Policy"},{"key":"pone.0320423.ref040","doi-asserted-by":"crossref","first-page":"107896","DOI":"10.1016\/j.drugalcdep.2020.107896","article-title":"Legal requirements and recommendations to prescribe naloxone","volume":"209","author":"RL Haffajee","year":"2020","journal-title":"Drug Alcohol Depend"},{"key":"pone.0320423.ref041","article-title":"FDA approves higher dosage of naloxone nasal spray to treat opioid overdose [press release]","year":"2021"},{"key":"pone.0320423.ref042","doi-asserted-by":"crossref","first-page":"108790","DOI":"10.1016\/j.jsat.2022.108790","article-title":"\u201cIf I had them, I would use them every time\u201d: Perspectives on fentanyl test strip use from people who use drugs","volume":"140","author":"MK Reed","year":"2022","journal-title":"J Subst Abuse Treat"},{"issue":"1","key":"pone.0320423.ref043","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/s12954-024-01075-x","article-title":"The fentanyl made me feel like I needed more methadone\": Changes in the role and use of medication for opioid use disorder (MOUD) due to fentanyl","volume":"21","author":"M Bolshakova","year":"2024","journal-title":"Harm Reduct J"},{"key":"pone.0320423.ref044","doi-asserted-by":"crossref","first-page":"104366","DOI":"10.1016\/j.drugpo.2024.104366","article-title":"Radical hospitality: Innovative programming to build community and meet the needs of people who use drugs at a government-sanctioned overdose prevention site in San Francisco, California","volume":"126","author":"LD Wenger","year":"2024","journal-title":"Int J Drug Policy"},{"issue":"6","key":"pone.0320423.ref045","doi-asserted-by":"crossref","first-page":"833","DOI":"10.2105\/AJPH.2020.305612","article-title":"A low-barrier and comprehensive community-based harm-reduction site in Vancouver, Canada","volume":"110","author":"M Olding","year":"2020","journal-title":"Am J Public Health"},{"key":"pone.0320423.ref046","article-title":"Canada\u2019s first opioid vending machine launches in Vancouver [Internet]","author":"A Thibault","year":"2020","journal-title":"CTV News"},{"key":"pone.0320423.ref047","volume-title":"Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction","author":"M Szalavitz","year":"2021"},{"key":"pone.0320423.ref048","volume-title":"\u201cSuccess Is Unacceptable If It\u2019s Not Our Way.\u201d","author":"M Gray","year":"August 26, 1998"},{"key":"pone.0320423.ref049","volume-title":"\u201cDrug-Related Deaths,\u201d","author":"Swiss Health Observatory","year":"August 29, 2022"},{"issue":"6","key":"pone.0320423.ref050","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1111\/j.1360-0443.2008.02185.x","article-title":"Long-term effects of heroin-assisted treatment in Germany","volume":"103","author":"U Verthein","year":"2008","journal-title":"Addiction"},{"issue":"1","key":"pone.0320423.ref051","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s12954-023-00776-z","article-title":"Safer opioid supply: Qualitative program evaluation","volume":"20","author":"M Haines","year":"2023","journal-title":"Harm Reduct J"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320423","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T23:24:29Z","timestamp":1743636269000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320423"}},"subtitle":[],"editor":[{"given":"Lalit","family":"Gupta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":51,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0320423","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,2]]}}}