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Official websites use. Share sensitive information only on official, secure websites. Contact person: Peter Meylakhs, Kantemirovskaya st. We conducted a mixed methods study of young age 18—26 hard drug users in St. Thirty-nine structured and 10 semi-structured interviews were conducted. A new cohort of drug users in St. Petersburg may have emerged, which is much safer in its injection practices compared to previous cohorts. However, risky sexual practices among this new cohort may expose them to the possibility of sexual transmission of HIV and widespread drug paraphernalia sharing to the HCV epidemic. Se realizaron 39 entrevistas estructuradas y 10 semiestructuradas. Russia is one of the countries with the highest incidence rates of HIV infection 1. Petersburg with its estimated 80 PWID 5. Petersburg in particular, are well documented 6 — Petersburg from to 7 , 11 — Additionally, the HCV prevalence rate also increased from Petersburg, Russia 1. This is similar to previous studies that found the overwhelming majority of respondents named heroin as their drug of choice 15 , Petersburg, we can see that it examined roughly the same generational-grouping of drug users — those who felt the full brunt of the effects of the transition that occurred in Russia in the s, including the opioid and HIV epidemics, that were in their early twenties at the turn of the century, turning 30s in , and are now in their mid-thirties. Petersburg, those whose age is currently in the range of 18—29 years. For instance, studies conducted among young under 25 years new injectors in Vietnam 22 and heroin injectors in United Republic of Tanzania aged 17—25 years 23 provide evidence of high HIV prevalence - varying from Moreover, in St. A number of studies in different countries have found that young PWID are less likely to know or apply safer injection practices 26 and are more inclined to share syringes and other drug paraphernalia than older PWID 23 , 27 — Given the lack of studies of young drug users in St. Petersburg in recent years and the fact that this group is particularly vulnerable to HIV infection and other risks, we undertook a mixed-methods pilot study of young age 18 — 26 hard drug users in St. Petersburg as a precursor to attempting to organize a major respondent driven sampling RDS study informed by the results of the pilot project. In this pilot we sought to explore what substances are used by young drug users, their drug use patterns and trajectories, drug use and sexual network characteristics, risk injection and sexual practices, overdose risks, HIV and HCV prevalence, and other issues related to drug use. We employed a mixed-methods research design to capitalize on the relative strengths of both quantitative and qualitative research perspectives. We started the pilot by collecting and conducting preliminary analysis of qualitative data phase 1. To be eligible for the qualitative study, informants had to be: 18—26 years old, report any drug use apart from cannabinoids in the past 30 days, reside in St. Petersburg, speak Russian, and able to provide written informed consent. However, we were unable to recruit young age 18 — 26 hard drug users through these venues. We extended our search for informants by incorporating the City Drug Treatment Center and exploiting our good relations with the local Narcotics Anonymous NA community, again offering rubles as an incentive for recruitment of a study subject eligible for the study. We also asked our research interns to bring to the study their friends and acquaintances, if they were eligible for the study and ready to take part in it. These strategies proved fruitful and we managed to recruit 10 participants. Two were recruited at the City Drug Treatment Center, both at the higher end of our age range 26 years old ; eight were recruited through our NA connections. Serological status was self-reported. Amphetamine was the drug of choice for three of the subjects, one regularly used methadone, and the rest reported polydrug use. Nine out of ten respondents reported injecting drug use methadone, amphetamine, mephedrone, or their combination. Data collection, consisting of semi-structured interviews, was conducted in February Informants were interviewed in cafes or a private room at the City Drug Treatment Center. Interviews were conducted in Russian language, recorded, and lasted on average around 90 minutes. All participants provided written informed consent and were reimbursed for their time and effort with the sum in rubles equal to 15 USD. Interviews were conducted by two members of the research team PM and AD. The names of the informants have been changed to pseudonyms. The qualitative part of the study was approved by the Ethical Committee of the St. Petersburg Association of Sociologists. Participants were recruited from February through April using RDS, a method designed to overcome some of the biases inherent in the non-random nature of sampling hard-to-reach populations without a clear sampling frame 37 , Eligibility criteria were the same as in the qualitative part, with one addition: participants had to be willing both to self-test for HIV and HCV in the presence of the interviewers immediately after completing structured interviews and also to disclose their test results to them. Participants who looked 25 or older were asked to produce their photo ID for age verification. Drug use was self-reported; those who reported recent injection use were visually assessed for injection marks. Seeds were provided with three coupons with which to recruit other eligible participants. This process was repeated with recruited participants until we had engaged 39 subjects, after which we stopped recruiting subjects due to the budget considerations. We used a dual-incentives system: each participant received the ruble equivalent of 8 USD for taking part in the study and the ruble equivalent of 8 USD for each study participant successfully recruited. Structured interviews lasted between 90 to minutes and included the same thematic blocks that were used in the qualitative phase. In writing the questionnaire items, we drew on language used by the participants in semi-structured interviews, where necessary, to help word questions appropriately. Additionally, based on results of preliminary analysis of semi-structured interviews, we introduced questions related to social distance between different categories of drug users with respect to types of drugs used, routes of their use, injection practices and serological status. Following Karakayali 39 , we view social distance as a multidimensional phenomenon and adopt the concepts of affective and interactive distances as separate aspects of social distance; thus affective distance is measured in terms of attitudes and emotions toward the group, whereas interactive distance reflects the frequency of interaction between the groups. Participant interviews were transcribed verbatim. Thematic analysis 40 was conducted with the aid of a free software program called Open Code 3. All interviews were initially coded using a priori codes developed on the basis of the interview guide, and then data were coded again inductively based on emergent findings from the data. To exclude possible discrepancies in interpretations, the coders met after every third transcript was coded and disputes in interpretation were resolved on a consensus basis. Variables were summarized using medians and interquartile ranges IQR or relative frequencies and percentages, as appropriate. In this section we first present the results of the quantitative part of the study and then elaborate them or illustrate them with qualitative data in accordance with Complementarity Design. We report percentages for the quantitative data only. Petersburg 4. Sociodemographic characteristics, HIV testing and drug use behaviors among 39 young people who use drugs in St. Petersburg, Russia, Exclusive use of amphetamine was more prevalent among NIDU, none of whom used mephedrone. We can see from this data that opiates are much less popular among young hard drug users compared to their popularity among older drug using cohorts. Seventy-two percent reported injecting in the past 90 days. Injection practices among 29 young people who inject drugs in St. In the qualitative interviews participants told us of their fear of contracting HIV and HCV, and also that non-sharing of syringes was to a large extent a matter of personal hygiene. The following exchange illustrates this point:. Informant: Yes, I think so, naturally. However, the data on sharing other drug preparation paraphernalia i. Ksenia, who got tested and learned that she was HCV-positive during her first several months after she started to inject and later underwent HCV treatment, explains:. Before I was told that you just have to watch that you always have your own syringe. Junkies told me this, and I thought so The qualitative data show that in addition to not sharing syringes, many participants took care of themselves in multiple ways. They sniffed drugs if they did not have their own syringe. They tried to maintain nutrition even when they were not feeling hungry, took vitamins, mineral supplements, used medicines for vein treatment, and visited a doctor when they were sick. The following quote illustrates this point of safety embedding:. Sergey aged 20, PWID carried naloxone with him because he could find himself in a company where opiates were used, despite the fact that he did not use opiates himself. Ksenia describes how safety norms can even be enforced:. Sexual practices in past 90 days among 39 young people who use drugs in St. Petersburg, Russia, , by sex. We then explored affective and interactive distances that exist between different categories of drug users with respect to types of drugs, patterns of their use as well as behaviors and outcomes associated with drug use e. As mentioned above, we interpret affective distance in terms of attitudes and emotions toward a particular group and interactive distance - as a frequency of interaction with members of the group. The data suggest that opiate use is controversial. The qualitative data support the quantitative on this dual status of opiates. So therefore, I hid it from them However, several of them were disillusioned after trying it. As Lena tells:. Well, one time. We thought that it was something special, as people say, it is the best of all drugs. These pilot data suggest that a new generation of hard drug users, that is quite different in their drug use practices from older generations of PWUD in St. Petersburg, may have emerged. However, Kornilova et al. Obviously, a larger study or studies are needed to confirm or refute this statement. Further studies must explicate these and other aspects of different social contexts for different generations of drug users in Russia. Nearly half of the participants used only amphetamines, and a substantial number used amphetamines and novel psychoactive substances NPS such as mephedrone also a stimulant , whereas opioids were used by a much smaller number of participants and almost always episodically. Both serological and behavioral data indicate that this generation seems to be much safer in its injection practices than older PWID cohorts - none of the participants reported syringe sharing in the past 12 months, and about half the subsample reported using new syringes only. Lower rates of syringe sharing among young PWID are observed not only in Russia but in countries with similar histories of drug epidemics, such as Estonia and Ukraine where younger PWID inject more safely than their older peers 45 , This raises an intriguing and important question: how did these new pro-safety norms among young hard drug users in St. Petersburg emerge, especially in the context of a Russian drug policy that neglects and often opposes harm reduction among PWID? The answer clearly does not reside in the fact that new generation switched to stimulants since a number of studies report that injection of amphetamine-type stimulants is associated with more needle sharing compared to opiates 49 — Also, to add complexity to the question, a number of studies have found that young injectors are particularly vulnerable to HIV and HCV infections 19 , 20 but our study data do not show this. We can learn from this pilot study that relationships between drug and HIV policies and behavioral and serological outcomes cannot be reduced to policies per se and involves much more complex social and cultural processes. Also, broader policies and socioeconomic conditions are very important. These conditions appeared not as governmental AIDS response but were formed by market forces after the collapse of the Soviet Union. Sound HIV and drug policies are extremely important. This is shown by numerous successful implementations of syringe exchange programs throughout the world 53 , However, programs and policies are not everything. Collective representations of acceptable and unacceptable behaviors such as syringe sharing or lack thereof seem to be quite resilient and independent of policies. This parallels the relative lack of influence of drug policy on the prevalence of drug use and drug addiction. Similarly, Friedman et al. These data suggest that such independence between policy and enforcement and behaviors exists for injection risk behavior as well as for the number of people who use drugs. The results of this pilot study indicate a possible norm change regarding injection safety among young hard drug users in St. Petersburg, Russia. Previous studies 58 — 60 have suggested an important part of the norm change process: stigmatization of the previous cohort, the substance s they use, the way they administer these substances, and behavioral norms around their consumption. Stigmatization of opiate users and particularly of old opiate users was also observed in both qualitative and quantitative data. Aversion to the older opiate users may be related to a stigmatized image of a heavy opioid user or may be a psychological strategy against greater involvement in opiate use or both. More research is needed on this topic. It also potentially guards them from absorbing norms supportive of syringe sharing that are widespread in the older PWID injection networks. Separateness from older opioid cohorts along with safer injection behaviors found in our sample may make them resilient to parenteral HIV-infection. This is epidemiologically parallel to Friedman et al. Similar findings regarding negative interpretation of effects of heroin and cocaine by inexperienced users were reported by Bancroft et al. As a result, many participants discontinued opiate use. More research is needed to clarify whether this phenomenon is related to poor heroin and methadone quality in the St. Petersburg drug market, the subjective and social nature of the drug high described in the literature 67 — 69 , or both. Though the low prevalence of HIV and HCV detected in the sample is encouraging, considerable risks exist with regards to HCV- and HIV-infection via indirect sharing and sexual transmission, since few participants reported that they never shared drug paraphernalia and only a tenth reported consistent condom use. Also worrisome is that over two thirds of the respondents reported having known someone who died of overdose. Indeed, in qualitative interviews several informants told us that they themselves had had opiate overdoses while using opiates episodically, and knew episodic opiate users who had died of opiate overdose. The spread in Russia of fentanyl and fentanyl-type substances renders the opiate overdose problem, perhaps particularly among inexperienced users, especially critical. Petersburg , at the end of a number of interviews we asked the respondents whether they would be willing to exchange syringes at syringe exchange programs. The answer was always negative. When probed why, informants named financial well-being and the cheap price of syringes. These findings are in accordance with those that report an unwillingness of young drug injectors to access harm reduction services in other settings It may turn out that SEPs are not attractive to young hard drug users. However, this study shows that participants are often involved in providing their peers with clean injecting equipment, supporting safe injecting practices and discouraging unsafe ones — actions that Friedman et. Intraventions can be a powerful vehicle for reduction of various risks among PWID, especially in the settings where sufficient harm reduction services are lacking, like in Russia High digital literacy every participant used the Internet on a daily basis and youth civic potential can also be capitalized upon — HIV and drug user online and offline activism may be attractive to this group of highly educated young hard drug users. This study has several limitations. First, due to the pilot nature of the data and small sample size, data analysis was performed in an exploratory manner so all p-values should be interpreted as indicators that there might be some relationships, which should be verified in further studies. Third, one of the primary reasons for using RDS procedures in this study, despite the small sample size, was to demonstrate feasibility of an RDS study of young hard drug users in St. Previous research 25 showed that HIV prevalence was very high among street youth who injected drugs in recent years in St. Petersburg, but we were unable to recruit this group of PWID. Petersburg young hard drug users. Substance consumption was self-reported without confirmatory toxicology. Behavioral data can be inaccurate due to recall and social desirability bias. Thus, participants may have over-reported the use of sterile needles. Social distance from opiate users among 39 young people who use drugs in St. Petersburg in As a library, NLM provides access to scientific literature. AIDS Behav. Show available content in en es. A new generation of drug users in St. Petersburg, Russia? Find articles by Peter Meylakhs. Find articles by Samuel R Friedman. Find articles by Anastasia Meylakhs. Find articles by Pedro Mateu-Gelabert. Find articles by Danielle C Ompad. Find articles by Alisa Alieva. Find articles by Alexandra Dmitrieva. PMC Copyright notice. Open in a new tab. Petersburg resident registration 0. Petersburg 21 24 10 Ethnic group 0. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Median age in years IQR 2. Polydrug use 4. Ever experienced physical dependence on opiates. Ever overdosed 5. Median years of injection drug use IQR 1. Median age at first injection in years IQR. Spoke with people inject with about the need to inject safely in the past 6 months. Did not inject in past 6 months or missing. Supplied sterile syringes to people inject with in the past 6 months. Made sure had enough sterile syringes so can provide to others in the past 6 months. They will not be invited into our company again. Everything will continue as if nothing happened. Median number of vaginal, anal, or oral sex partners IQR 2. Number of partners that were regular drug users. Number of partners that were drug injectors in past 90 days.

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Correspondence to: EunYoung Kim, eykimjcb cau. To determine how drug dealers avoid social media surveillance, the cross-sectional study used fentanyl-related data from Twittersphere and Tumblrsphere. The three-stagee process with data collection, preprocessing, and forensic tracking of fentanyl sales and promotion was performed. Twitter data were consistent between January and June , while Tumblr data were more up-to-date. From January to June , tweets and, from January to July , , Tumblr posts related to fentanyl were gathered. A higher proportion of Tumblr data , Twitter has been successful in limiting the sale of opioids. However, more attention should be paid to non-English languages. Researchers, governments, and social media companies must collaborate to positively maintain social networking platforms to prevent the illicit sale of drugs through them. Keywords fentanyl, illicit online drug sales, social media, Twitter, Tumblr. The use of illicit substances has increased with the growth of the Internet and social networks. The International Narcotics Control Board recognizes that there is a link between social media and drug use International Narcotics Control Board This is especially true for young people, as they use social media the most and have a high drug use rate Riehm et al. Due to concerns about its extreme potency, fentanyl was initially approved in combination with droperidol by the United States Food and Drug Administration Stanley Despite these concerns, fentanyl is widely used in clinical practice Comer and Cahill However, like other opioids, repeated use of fentanyl leads to dependence Han et al. One is the illicit production and diversion of the drug in the United States Kerensky et al. The other is the unprescribed and unsanctioned use of pharmaceutical fentanyl in Western Europe Sinicina et al. Existing studies on cryptomarkets and the dark web fall into this category Extance Social media policy is evolving in response to these studies Kazemi et al. In the present study, we intend to follow Rawi's definition and method. We investigated two social media platforms for which we could gather data, Twitter and Tumblr Fung et al. Moreover, we attempted to answer three research questions. First, are the established social media research methods used to study illegal drug sales still relevant? Second, by combining previous research methods, can the new ways in which drug dealers use social media as a DSM be identified? Third, at what times and using which techniques do drug dealers use social media as a DSM? To examine the link between social media and drug use in this cross-sectional study, considering recent changes in application program interface API access regulations and accessibility, Tumblr and Twitter data were analyzed Al-Rawi ; Facebook Twitter was included for its alleged efforts to limit illegal activities on the platform. The study was conducted in three stages: data collection cloud-based computing , data preprocessing, and data tracking with the forensic examination Mackey et al. Data were collected in two steps. In stage II, data preprocessing was performed. Table 1 Data preprocessing results. Web forensics focused on websites and individual dealers linked to external web pages, photo images, videos, emoticons, hashtags, and direct messages. Counts and percentages were used to represent discrete variables. The Python Programming Language 3 interface for streaming application programs was used for data collection. All analyses were conducted using RStudio Version 4. A P value lower than 0. After analyzing their content, 61 In step II, Tumblr posts from the previous year were collected Fig. For forward data analysis, the target dataset of Tumblr posts from July collected on August 1, decreased to posts by August collected on September 7, Fig. In stage II, data preprocessing was conducted Table 1. Half of the Tumblr data were related to the non-medical use of fentanyl, which is consistent with previous research Cavazos-Rehg et al. The 10 most frequent drug words, except fentanyl, are drug-related words mentioned Table 2. Table 2 The 10 most frequent drug words, except fentanyl, used in the data includes duplicates. Among 1, posts, posts from 51 Tumblr IDs were found. Group A comprised 19 individual sellers who used images within e-mails, social networking site SNS accounts, and direct messages. E-mails 7 and phone numbers 5 were the primary sources of contact. Group B was further subdivided into B1, B2, and B3. In the August web forensics test, 30 hyperlinked homepages were discovered, of which 24 were active We used WHOIS to ensure that the address on the webpage matched the address for the registered domain. Group B used e-mails 22 and phone numbers 19; 3 were duplicates. There were 2 IDs links to other blogs or homepages that redirected users to sites selling fentanyl illegally. In stage III, data tracking was conducted Fig. Group B was the most active In Group A, 15 of 30 posts were inactive. At the second follow-up October 1, , 33 datasets remained, all belonging to Group B2. A group of sellers with the same phone number used three different Tumblr IDs and links to set up illegal online shops for fentanyl. The self-proclaimed location of the online shop was the United States; however, the IP belonged to India, Bangladesh, and another undisclosed location. Our study aimed to understand how drug dealers avoid social media surveillance. To this end, we collected and analyzed fentanyl-related data from social media. We examined fentanyl-related data from Twitter and Tumblr, using three-stage data tracking with forensic examination to determine how drug dealers avoid social media surveillance. Drug dealers who are active on SNSs continuously search for loopholes and find innovative ways to advertise their goods. The web forensic analysis showed that drug dealers use social media as a gateway to connect with new customers. Regarding the second research question, by combining previous research methods, we identified the new methods used by drug dealers on the DSM. Combining the methods of Mackey Mackey et al. Data preprocessing showed that a higher percentage of Tumblr data \[ This contrasts with Instagram and Facebook, which censor both positive and negative fentanyl-related activities Al-Rawi Further, we compared other drugs mentioned on Twitter and Tumblr Table 2. Regardless of the drug class, meth, cocaine, and heroin were the most popular drugs on Twitter, whereas heroin—a narcotic like fentanyl—was mentioned most frequently on Tumblr. For a cross-sectional study of Tumblr and Twitter data, a fast data tracking and analysis method was used. The results differed from previous research Mackey and Kalyanam ; Mackey et al. Mackey et al. We included hashtags and emoticons in our study and found that Group A individual sellers used them the most. Additionally, Group B2 included clandestine hyperlink sites that may be illegal. Tumblr provides a procedure for deleting negative posts or suspending IDs for text but not for images. Therefore, it is essential to employ image, hashtags, and emoticons analysis to prevent the activities of individual dealers. We found examples of the strategies used by fentanyl dealers that exploit loopholes in Tumblr Fig. Three different Tumblr IDs belonged to the same seller, as they used the same international phone number. Immediate action is required to prevent people from linking to illicit drug-sale websites. Therefore, extra effort is required for those languages. The government and social media companies must find ways to collaborate to fight against illegal drug sales through international IP addresses. Additionally, given the recent changes in API access regulations and accessibility, Tumblr and Twitter were chosen for this study, as prior studies focused on one or two SNSs Mackey et al. In this study, we found Twitter has been successful in limiting the sale of opioids, but attention should be paid to non-English languages. Third, it is important to use an image, hashtag, and emoticon analysis tools to track and stop individual dealers. Social media companies also must collaborate with governments and researchers to positively maintain social networking platforms to prevent the illicit sale of drugs. This study has some limitations. First, we did not interact with the accounts to confirm whether the drugs were available, as this is prohibited by law, even for research purposes. Second, there was a time lag in data collection. Data preprocessing was performed via manual annotation and classification. Future research combining machine learning and image analysis is expected to overcome these limitations. This study was based on fentanyl-related data collection from Twitter and Tumblr, using three-step data tracking with forensic examination to determine how illegal drug dealers avoid social media surveillance. First, given the cycle of activity of drug dealers, regulated substances should be closely monitored on social media. Second, individual dealers must be identified and stopped using image, hashtag, and emoticon analysis. Finally, researchers, governments, and social media companies must collaborate to positively maintain social networking platforms to prevent the illicit sale of drugs through such platforms. Table 1. Data preprocessing results. Table 2. The 10 most frequent drug words, except fentanyl, used in the data includes duplicates. Statistical analysis Counts and percentages were used to represent discrete variables. Figure 1. Summary of methodology and the main findings. Figure 2. Step I and II of data collection. Original analysis data collection date: August 1 , first follow-up September 7 , and second follow-up October 1 of Tumblr posts. Data preprocessing In stage II, data preprocessing was conducted Table 1. The 10 most frequent drug words, except fentanyl, are drug-related words mentioned Table 2 Table 2 The 10 most frequent drug words, except fentanyl, used in the data includes duplicates Rank Drugs Twitter Tumblr 1 Amphetamine meth 1, Individual drug dealers: group A Group A comprised 19 individual sellers who used images within e-mails, social networking site SNS accounts, and direct messages. Figure 3. Tracking results July , of changes in illegal fentanyl sales and promotion data on Tumblr. Original analysis data collection date: August 1, forensic date: August 27 , first follow-up data collection date: September 7, forensic date: September 7 , second follow-up collection date: October 1, forensic date: September 7. Group A: Individual drug dealer. Group C: Indirect seller. Figure 4. A representative example of online illegal fentanyl sale shops avoiding social media surveillance Group B3: No database and inactive website; Group B1: Rogue website; Group B2: No database and active website. The authors declare that they have no conflict of interest. Al-Rawi A The convergence of social media and other communication technologies in the promotion of illicit and controlled drugs. J Public Health Oxf ee Telemat Inf Branley DB, Covey J Pro-ana versus pro-recovery: a content analytic comparison of social media users' communication about eating disorders on Twitter and Tumblr. Front Psychol Forensic Sci Int Crisis Neurosci Biobehav Rev Extance A The future of cryptocurrencies: Bitcoin and beyond. Nature Facebook Supplemental bulletin data policy. J Med Internet Res e Perm J Transl Psychiatry J Public Health Oxf J Addict Med Int J Drug Policy Am J Public Health Mackey T, Kalyanam J, Klugman J, Kuzmenko E, Gupta R Solution to detect, classify, and report illicit online marketing and sales of controlled substances via Twitter: using machine learning and web forensics to combat digital opioid access. FRes J Clin Pharm Ther Prosecution Service Narcotics Crime Paper year report. Prosecution Service. JAMA Psychiatry Shin JH Juvenile drug cases on the rise. The Korean Herold. Drug Alcohol Depend Stanley TH The fentanyl story. J Pain Stanley TH The history and development of the fentanyl series. Swart J, Peters C, Broersma M Shedding light on the dark social: the connective role of news and journalism in social media communities. New Media Soc BMC Public Health Article Tools Split Viewer. Contents Figure Table References. Keywords : fentanyl, illicit online drug sales, social media, Twitter, Tumblr. Materials Methods. The 10 most frequent drug words, except fentanyl, are drug-related words mentioned Table 2 Table 2. Rank Drugs Twitter Tumblr 1 Amphetamine meth 1, Fig 1. Fig 2. Fig 3. Fig 4. Table 2 The 10 most frequent drug words, except fentanyl, used in the data includes duplicates Rank Drugs Twitter Tumblr 1 Amphetamine meth 1, Stats or Metrics Crossref 0 View Download Share this article on :. Related articles in DTT. Drug Targets and Therapeutics ; The Pharmaceutical Society of Korea. Share by SNS Close. Non-medical use of fentanyl. Sales and promotion of fentanyl.

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