Expanding harm reduction to include fentanyl urine testing: results from a pilot in rural British Columbia

Abstract

BackgroundHarm reduction has been at the forefront of the response to the opioid overdose public health emergency in British Columbia (BC). The unprecedented number of opioid overdose deaths in the province calls for an expansion of harm reduction services. The purpose of this study was to determine the acceptability of a fentanyl urine drug test among people who use drugs (PWUD) and explore whether testing introduced any changes in participants’ attitudes and behaviors towards their drug use.MethodsA pilot of fentanyl urine testing was implemented in partnership with an outreach harm reduction program in rural BC. Participants were PWUD who had consumed within the last 3 days prior to the test. Participants filled out a semi-structured questionnaire at the time of the test and were invited for a follow-up interview 2 to 4 weeks after the test. Urine samples were tested with BNTX Rapid Response™ fentanyl urine strip test at a detection level of 20 ng/ml norfentanyl.ResultsOf the 24 participants who completed the urine test and first interview, 4 had a positive fentanyl urine test. Fifteen clients completed the second questionnaire, 10 of whom reported introducing a behavior change after testing and the remaining 5 indicated being already engaged in harm reduction practices. All four clients who tested positive completed the second questionnaire; all but one indicated adopting behaviors towards overdose prevention.DiscussionFentanyl urine testing appealed to illicit opioid users and may have contributed to adopting behaviors towards safer drug use. A relationship of trust between tester and client seemed important for clients who expressed concerns with privacy of the urine test results. Post-consumption urine testing could complement the use of pre-consumption drug checking in the context of harm reduction services.Electronic supplementary materialThe online version of this article (10.1186/s12954-018-0224-z) contains supplementary material, which is available to authorized users.

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

“…This finding resonates with other studies in which trust has been identified as a key factor influencing access [41,[52][53][54]. We also heard how the most significant factor was that individuals involved be respectful regardless of if they identify as a person who uses drugs or not; this aligns with recent findings of a fentanyl test strip pilot project [55]. Moreover, given the high levels of trauma experienced as part of the overdose crisis, a trauma-informed approach [56] is required for service delivery.…”

Urine drug screening for early detection of unwitting use of fentanyl and its analogues among people who inject heroin in Sydney, Australia

“…Unlike similar Canadian studies , we found no evidence of fentanyl‐laced heroin through urine screens among people who inject ‘heroin’ in Sydney, Australia. Regarding feasibility and acceptability, clients appeared interested in whether their heroin contained fentanyl, as demonstrated among similar populations elsewhere . The instant urine tests were easy to use in a community health setting.…”

“…Further work should establish the extent to which positive tests result in changes to substance use patterns. This is a promising area of inquiry: previous studies have found that point‐of‐care detection of fentanyl and analogues in drug samples (‘drug checking’) offers clients an opportunity to avoid consuming specific drug batches and increases reports of harm‐reducing practices .…”

“…Urine screening for fentanyl and derivatives is a relatively easy way of incorporating surveillance within client services. Four Canadian studies have utilised urine screening in community settings to monitor the unintended consumption of fentanyl (and analogues). In 2015, Amlani et al .…”

“…A pilot study by Mema et al . (2017) with 24 rural harm‐reduction clients, found four tested positive for fentanyl, but most of these were not surprised by the result, perhaps due to the acceptance of fentanyl adulteration in Canadian heroin supplies . All studies used BTNX Rapid Response™ fentanyl urine strips: Amlani et al .…”