Effect of positive urine fentanyl screen on attitudes toward heroin use

Konchak, Juleigh Nowinski; McGurk, Kevin; Hinami, Keiki; Vacchiano, Margaret; Aks, Steven E.

doi:10.1016/j.drugalcdep.2020.107934

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…Expansion of fentanyl's presence on urine drug screening may be warranted to detect potential exposure to high-potency opioids, which may or may not be known to patients (22,23). A previous study at the same health system found that 75% of patients with a positive urine fentanyl screen were not aware of or expecting fentanyl to be present in their urine, indicating that many exposures from the current study were likely not intentional or known to patients (23). However, fentanyl screening does not take into account other synthetic opioids.…”

Section: Discussionmentioning

confidence: 99%

A cross-sectional analysis of fentanyl analog exposures among living patients

Chhabra

Rizvanolli

Rasin

et al. 2021

The American Journal of Drug and Alcohol Abuse

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Background: Synthetic opioids, including fentanyl analogs, contribute to an increasing proportion of opioid-related deaths. Highly potent analogs pose an increased risk for fatal overdose. The prevalence of fentanyl analog exposures in patients with known opioid exposure is unknown. Objective: The purpose of this study was to determine the exposure prevalence for fentanyl analogs in living patients with positive urine screens for opiates or fentanyl. Methods: This was a cross-sectional analysis of urine high performance liquid chromatography/ tandem mass spectroscopy (HPLC-MS/MS) results from patients with a positive urine screen for opiates or fentanyl at a large public healthcare system in Chicago, Illinois. Samples with positive screens were non-continuously tested by HPLC-MS/MS for 5 selected months in 2018 and 2019. Results: A total of 219 urine samples which screened positive for fentanyl or opiates underwent HPLC-MS/MS testing. At least one fentanyl analog was detected in 65.3% (n = 143) of samples with 26.0% (n = 57) testing positive for multiple analogs. The most common analogs, intermediates, or metabolites were: 4-ANPP (n = 131); 2-furanylfentanyl (n = 22); acryl fentanyl (n = 21); butyrylfentanyl (n = 15); cyclopropylfentanyl (n = 15); and carfentanil (n = 13). Of samples which screened positive for fentanyl (n = 188), 70.2% (132) tested positive for at least one fentanyl analog. Of samples which screened negative for fentanyl but positive for opiates (n = 31), 35.5% (n = 11) tested positive for fentanyl analogs Conclusion: Fentanyl analog exposure is common in patients with positive urine screens for fentanyl or opiates. Screening living patient samples for synthetic opioids has future toxicosurveillance implications and these data underscore the increased risks from illicit opioid use.

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Section: Discussionmentioning

confidence: 99%

A cross-sectional analysis of fentanyl analog exposures among living patients

Chhabra

Rizvanolli

Rasin

et al. 2021

The American Journal of Drug and Alcohol Abuse

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The discounting of death: Probability discounting of heroin use by fatal overdose likelihood and drug purity.

Dolan

Johnson

Dunn

et al. 2021

Experimental and Clinical Psychopharmacology

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As fatal overdoses from synthetic opioids continue to rise, we need to understand decision-making processes underlying heroin and synthetic opioid use. This study evaluated the influence of sample impurity and fatal overdose risk on hypothetical heroin use. Individuals who currently use heroin (n = 69) were recruited online. Participants completed two probability-discounting tasks evaluating the likelihood of using a sample of heroin based on the likelihood of sample impurity and likelihood of fatal overdose, where greater discounting represented reduced use likelihood. Prior to completing the probability-discounting tasks, participants were randomized to read one of four prompts varying by the presence of information on heroin effects and active (e.g., fentanyl) or inert impurities. Influence of prompts on discounting processes and associations among probability-discounting measures, opioid use behaviors, and dependence severity were evaluated. Heroin use likelihood decreased with increased impurity or overdose risk and in a generally orderly fashion. Discounting was greater (i.e., reduced heroin use likelihood) when overdose risk, compared to sample impurity, was manipulated. Less discounting was associated with more severe opioid dependence. Discounting did not differ among prompts for either task. Individuals might adjust their heroinuse behavior to reduce harm with risk-related information. Greater discounting elicited by overdose relative to impurity risk suggests that equating adulteration and overdose risk is essential for harm reduction. Expanded access to drug checking services, which inform impurity and overdose risk, can reduce fatal overdoses. Due to fear of legal sanctions for these services, legislation and judicial decisions should explicitly protect these services. Public Health SignificanceWe found that heroin-use likelihood decreased as the chances of encountering an impurity or suffering a fatal overdose increased. These results suggest that some persons who use heroin will make safer druguse decisions with adequate information about the risks involved. Expanded access to and legal protections for drug-checking services, which inform heroin-related risk, have the potential to save lives by promoting harm-reduction behaviors among individuals who use heroin.

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Effect of positive urine fentanyl screen on attitudes toward heroin use

Cited by 2 publications

References 5 publications

A cross-sectional analysis of fentanyl analog exposures among living patients

A cross-sectional analysis of fentanyl analog exposures among living patients

The discounting of death: Probability discounting of heroin use by fatal overdose likelihood and drug purity.

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