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BackgroundBritish Columbia, Canada, is experiencing a public health emergency related to opioid overdoses driven by consumption of street drugs contaminated with illicitly manufactured fentanyl. This cross-sectional study evaluates a drug checking intervention for the clients of a supervised injection facility (SIF) in Vancouver.MethodsInsite is a facility offering supervised injection services in Vancouver’s Downtown East Side, a community with high levels of injection drug use and associated harms, including overdose deaths. During July 7, 2016, to June 21, 2017, Insite clients were offered an opportunity to check their drugs for fentanyl using a test strip designed to test urine for fentanyl. Results of the drug check were recorded along with information including the substance checked, whether the client intended to dispose of the drug or reduce the dose and whether they experienced an overdose. Logistic regression models were constructed to assess the associations between drug checking results and dose reduction or drug disposal. Crude odds ratios (OR) and 95% confidence intervals (CI) were reported.ResultsAbout 1% of the visits to Insite during the study resulted in a drug check. Out of 1411 drug checks conducted by clients, 1121 (79.8%) were positive for fentanyl. Although most tests were conducted post-consumption, following a positive pre-consumption drug check, 36.3% (n = 142) of participants reported planning to reduce their drug dose while only 11.4% (n = 50) planned to dispose of their drug. While the odds of intended dose reduction among those with a positive drug check was significantly higher than those with a negative result (OR = 9.36; 95% CI 4.25–20.65), no association was observed between drug check results and intended drug disposal (OR = 1.60; 95% CI 0.79–3.26). Among all participants, intended dose reduction was associated with significantly lower odds of overdose (OR = 0.41; 95% CI 0.18–0.89).ConclusionsAlthough only a small proportion of visits resulted in a drug check, a high proportion (~ 80%) of the drugs checked were contaminated with fentanyl. Drug checking at harm reduction facilities such as SIFs might be a feasible intervention that could contribute to preventing overdoses in the context of the current overdose emergency.

Background: The overdose epidemic has been exacerbated by a dramatic increase in deaths involving illicitly manufactured fentanyl (IMF). Drug checking is a novel strategy to identify IMF in illicit drugs. We examined the uptake and acceptability of rapid fentanyl test strips among young adults. Methods: From May to September 2017, we recruited 93 young adults in Rhode Island who reported injecting drugs or using heroin, cocaine, or illicitly obtained prescription pills in the past 30 days. Participants were asked to test either their urine after drug use (post-consumption) or a drug sample prior to use (pre-consumption) using rapid fentanyl test strips. After a questionnaire and a brief training, participants received ten strips for their personal use and were asked to return for a one-month follow-up visit, which assessed the uptake and acceptability of the rapid strips tests, and behavioral outcomes associated with receipt of a positive test. Results: Of the 81 (87%) participants who returned for follow-up and who had complete data, the mean age was 27, 45 (56%) were male, and 37 (46%) were non-white. A total of 62 participants (77%) reported using at least one test strip. Of these, 31 (50%) received at least one positive result. A positive result was associated with older age, homelessness, heroin use, injection drug use, ever witnessing an overdose, and concern about overdose or drugs being laced with fentanyl (all p < 0.05). Receiving a positive result was significantly associated with reporting a positive change in overdose risk behavior between baseline and follow-up (p ≤ 0.01). Among all participants, 79 (98%) reported confidence in their ability to use the test strips and 77 (95%) wanted to use them in the future. Conclusions: Young adults reported high uptake and acceptability of fentanyl test strips to detect IMF in illicit drugs.

BackgroundSynthetic opioid overdose mortality among young adults has risen more than 300% in the USA since 2013, primarily due to the contamination of heroin and other drugs with illicitly manufactured fentanyl. Rapid test strips, which can be used to detect the presence of fentanyl in drug samples (before use) or urine (after use), may help inform people about their exposure risk. The purpose of this study was to determine whether young adults who use drugs were willing to use rapid test strips as a harm reduction intervention to prevent overdose. We hypothesized that those who had ever overdosed would be more willing to use the test strips.MethodsWe recruited a convenience sample of young adults who use drugs in Rhode Island from May to September 2017. Eligible participants (aged 18 to 35 with past 30-day drug use) completed an interviewer-administered survey. The survey assessed participant’s socio-demographic and behavioral characteristics, overdose risk, as well as suspected fentanyl exposure, and willingness to use take-home rapid test strips to detect fentanyl contamination in drugs or urine. Participants were then trained to use the test strips and were given ten to take home.ResultsAmong 93 eligible participants, the mean age was 27 years (SD = 4.8), 56% (n = 52) of participants were male, and 56% (n = 52) were white. Over one third (n = 34, 37%) had a prior overdose. The vast majority (n = 86, 92%) of participants wanted to know if there was fentanyl in their drug supply prior to their use. Sixty-five (70%) participants reported concern that their drugs were contaminated with fentanyl. After the brief training, nearly all participants (n = 88, 95%) reported that they planned to use the test strips.ConclusionsMore than 90% of participants reported willingness to use rapid test strips regardless of having ever overdosed, suggesting that rapid fentanyl testing is an acceptable harm reduction intervention among young people who use drugs in Rhode Island. Study follow-up is ongoing to determine whether, how, and under what circumstances participants used the rapid test strips and if a positive result contributed to changes in overdose risk behavior.

With one in five PWID being exposed to fentanyl, there is an urgent need to design and scale up interventions to reduce overdose risk, including a range of opioid agonist therapies.

Introduction and AimsDrug checking is a harm reduction intervention increasingly used in the context of the opioid overdose epidemic. The aim of the study was to determine the limit of detection for fentanyl of two point‐of‐care drug checking technologies.Design and MethodsSamples tested at point‐of‐care using Bruker Fourier transform infrared (FTIR) spectroscopy and BTNX fentanyl immunoassay strips were sent for confirmatory laboratory analysis using quantitative nuclear magnetic resonance (qNMR) spectroscopy. Concentrations by weight were determined and compared to results obtained with point‐of‐care methods.ResultsIn total, 283 samples were sent for qNMR analysis; among these, 173 (61.1%) tested positive for fentanyl. As determined by qNMR, fentanyl concentration by weight ranged from 1% to 91%. Among these 173 samples, fentanyl was not detected in 30 (17.3%) samples by FTIR and in 4 (2.3%) samples by test strip. Samples containing fentanyl that went undetected by FTIR had concentrations ≤10%. The four samples containing fentanyl that went undetected by test strip had concentrations ≤5% (i.e. 1%, 3%, 4%, 5%).Discussion and ConclusionsFentanyl immunoassay strips were able to consistently detect the presence of fentanyl in samples at lower concentrations than FTIR spectroscopy. Given that FTIR spectroscopy is able to quantify content, mixture and concentrations on an array of compounds beyond just fentanyl but requires concentrations generally greater than 10%, these findings provide evidence for use of FTIR spectroscopy and immunoassay strips in combination to compensate for the limitations of each technology alone.

Drinking water related infections are expected to increase in the future due to climate change. Understanding the current links between these infections and environmental factors is vital to understand and reduce the future burden of illness. We investigated the relationship between weekly reported cryptosporidiosis and giardiasis (n = 7,422), extreme precipitation (>90th percentile), drinking water turbidity, and preceding dry periods in a drinking water system located in greater Vancouver, British Columbia, Canada (1997-2009) using distributed lag non-linear Poisson regression models adjusted for seasonality, secular trend, and the effect of holidays on reporting. We found a significant increase in cryptosporidiosis and giardiasis 4-6 weeks after extreme precipitation. The effect was greater following a dry period. Similarly, extreme precipitation led to significantly increased turbidity only after prolonged dry periods. Our results suggest that the risk of cryptosporidiosis and giardiasis increases with extreme precipitation, and that the effects are more pronounced after a prolonged dry period. Given that extreme precipitation events are expected to increase with climate change, it is important to further understand the risks from these events, develop planning tools, and build resilience to these future risks.

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