An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples

Green, Traci C.; Park, Ju Nyeong; Gilbert, Michael; McKenzie, Michelle; Struth, Eric; Lucas, Rachel; Clarke, William; Sherman, Susan G.

doi:10.1016/j.drugpo.2020.102661

Cited by 136 publications

(232 citation statements)

References 25 publications

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“…The Fentanyl Overdose Reduction Checking Analysis Study (FORECAST) was conducted in Baltimore (Maryland), Boston (Massachusetts) and Providence (Rhode Island); all cities with established opioid markets and rates of overdoses that have dramatically increased in recent years . The purpose of FORECAST was to investigate the validity and feasibility of drug checking resources for reducing overdose . Detailed methodology has been outlined elsewhere .…”

Section: Methodsmentioning

confidence: 99%

Trends in opioid initiation among people who use opioids in three US cities

Rouhani

Park

Morales

et al. 2020

Drug and Alcohol Review

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Introduction and Aims. The increased availability of prescription opioids (PO) and non-medical prescription opioids (NMPO) has fundamentally altered drug markets and typical trajectories from initiation to high-risk use among people who use opioids (PWUO). This multi-site study explores trends in opioid initiation in three US cities and associations with sociodemographic factors, current drug use and overdose risk. Design and Methods. We analysed survey data from a cross-sectional study of PWUO in Baltimore, Maryland (n = 173), Boston, Massachusetts (n = 80) and Providence, Rhode Island (n = 75). Age of first exposure to PO, NMPO and heroin was used to calculate opioid of initiation, and multinomial regression was employed to explore correlates of initiating with each. Results. Thirty-three percent of PWUO initiated with heroin, 24% with PO, 18% with NMPO and 24% with multiple opioids in their first year of use. We observed a reduction in heroin initiation and gradual replacement with PO/NMPO over time. Women were more likely to initiate with NMPO [relative risk ratio (RRR) 2.4; 95% confidence interval (CI) 1.1, 5.0], PO (RRR 2.2, 95% CI 1.1, 4.4) or multiple opioids (RRR 2.1, 95% CI 1.1, 4.2), than heroin. PWUO initiating with NMPO had significantly higher current benzodiazepine use, relative to those initiating with heroin (RRR 3.2, 95% CI 1.4, 7.4), and a high prevalence of current fentanyl use (30%). Discussion and Conclusions. Our study highlights women and PWUO initiating with NMPO as key risk groups amid the changing landscape of opioid use and overdose, and discusses implications for targeted prevention and treatment. [Rouhani S, Park JN, Morales KB, Green TC, Sherman SG. Trends in opioid initiation among people who use opioids in three US cities. Drug Alcohol Rev 2020;39: [375][376][377][378][379][380][381][382][383]

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Section: Methodsmentioning

confidence: 99%

Trends in opioid initiation among people who use opioids in three US cities

Rouhani

Park

Morales

et al. 2020

Drug and Alcohol Review

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“…Drug checking programs enable PWUD, without the risk of arrest, to have their drugs chemically analyzed for the presence of substances like fentanyl and its analogues and for their purity, thereby allowing for more informed decisions about subsequent drug use. [169][170][171][172] These programs, which were pioneered in Europe and are inclusive of laboratory-based and point-of-care models, have the potential to promote product safety in the illicit drug supply in the United States, where its use has been limited to testing drugs at music festivals and some SSP and community-based organizations. Such services are needed in the context of a large unregulated illicit market in which the quantity and purity of illicit drugs (eg, heroin) remain uncertain.…”

Section: Harm Reductionmentioning

confidence: 99%

Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework

Park

Rouhani

Beletsky³

et al. 2020

Milbank Quarterly

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110

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This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug‐related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. Context Drug overdose is the leading cause of injury‐related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. Methods In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The “continuum of overdose risk” framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. Findings De‐escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. Conclusions Without recognizing the full drug‐use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.

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“…It is within this context of fentanyl-related overdoses that drug checking has been re-emerging as a potential harm reduction intervention in Canada [6][7][8] and globally [9][10][11]. A 2017 evidence review of drug checking technologies and research concluded that communitywide drug checking may be instrumental as part of public health responses in British Columbia, and potentially a life-saving harm reduction service [12].…”

Section: Introductionmentioning

confidence: 99%

What is needed for implementing drug checking services in the context of the overdose crisis? A qualitative study to explore perspectives of potential service users

et al. 2020

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Background: The current illicit drug overdose crisis within North America and other countries requires expanded and new responses to address unpredictable and potentially lethal substances, including fentanyl analogues, in the unregulated drug market. Community-wide drug checking is being increasingly explored as one such public health response. We explored how drug checking could be implemented as a potential harm reduction response to the overdose crisis, from the perspective of potential service users. Methods: The research was guided by the Consolidated Framework for Implementation Research (CFIR). We conducted a qualitative, pre-implementation study to inform development and implementation of drug checking services that are acceptable to people who use substances and meet their needs. University and community researchers conducted 27 in-depth interviews with potential service users at prospective drug checking sites. We inductively developed emerging themes to inform the implementation of drug checking services within the five domains of the CFIR, and identified the most relevant constructs. Results: Implementing community drug checking faces significant challenges within the current context of criminalization and stigmatization of substance use and people who use/sell drugs, and trauma experienced by potential service users. Participants identified significant risks in accessing drug checking, and that confidential and anonymous services are critical to address these. Engaging people with lived experience in the service can help establish trust. The relative advantage of drug checking needs to outweigh risks through provision of accurate results conveyed in a respectful, non-judgemental way. Drug checking should provide knowledge relevant to using and/or selling drugs and informing one's own harm reduction.

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An assessment of the limits of detection, sensitivity and specificity of three devices for public health-based drug checking of fentanyl in street-acquired samples

Cited by 136 publications

References 25 publications

Trends in opioid initiation among people who use opioids in three US cities

Trends in opioid initiation among people who use opioids in three US cities

Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework

What is needed for implementing drug checking services in the context of the overdose crisis? A qualitative study to explore perspectives of potential service users

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