"Extremely cheap and extremely potent": Fentanyl Knowledge and Risk Practices AmongYoung People in Oregon Who Have Used Non-Prescription Pills.

Background: Overdose deaths involving illicitly manufactured fentanyl have risen sharply, particularly among young people, who are increasing exposed to counterfeit pills. While much is known about adult populations, little research explores how young people perceive and respond to the risks of fentanyl. Methods: From October 2023 to March 2024, we conducted semi-structured interviews with 21 young people in Oregon (ages 15 to 25) who had reported lifetime use of non-prescription pills. Interviews explored knowledge, experiences, risk reduction practices, and trusted information sources related to fentanyl and counterfeit pills. Transcripts were analyzed using thematic analysis. Results: Participants demonstrated broad awareness of the dangers of fentanyl and counterfeit pills and described fentanyl as potent, lethal, and increasingly prevalent. Knowledge varied, however, with some holding misconceptions (e.g., risk of overdose from touch). Participants reported practicing risk reduction strategies, including avoiding pills of uncertain sources, using fentanyl test strips, carrying naloxone, and monitoring peers' safety. Barriers such as limited access to resources, inconsistent availability of drug checking tools, and stigma constrained their ability to reduce risk. Participants described strong peer-to-peer networks that emphasized safety and mutual support. Finally, participants expressed a desire for accurate, fact-based, nonjudgmental education about fentanyl and drug use. They emphasized the importance of schools, parents, and public health organizations providing open dialogue, risk reduction information, and accessible supports such as mental health services, hotlines, and treatment. Conclusion: Young people in Oregon who have used non-prescription pills are aware of fentanyl's presence in the drug supply and are motivated to stay safe but encounter barriers that limit their ability to consistently practice risk reduction. Tailored, age-specific interventions that build on existing peer-to-peer networks and expand access to risk reduction resources-including naloxone, fentanyl test strips, and fact-based education-are urgently needed to reduce overdose risk and support young people's wellbeing.