Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States

Peiper, Nicholas; Clarke, Sarah Elizabeth Duhart; Vincent, Louise; Ciccarone, Daniel; Kral, Alex H.; Zibbell, Jon E.

doi:10.1016/j.drugpo.2018.08.007

Cited by 209 publications

(142 citation statements)

References 50 publications

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“…Nevertheless, accidental exposure to fentanyl consumption with resultant overdose has been reported in San Francisco [6,7]. The strong associations between opioid pain medications or heroin use and fentanyl detection echo prior research with opioid-using populations that reinforces the importance of communitybased naloxone distribution programs [22,23], fentanyl test strips [24,25], drug-checking services [26], and supervised consumption or overdose prevention sites [27,28], where overdose prevention services can be accessed. Although many people who use drugs are now aware of the possibility of fentanyl contamination, the regular application of overdose prevention measures is often inconsistent due to structural factors such as poverty and homelessness [29].…”

Section: Discussionmentioning

confidence: 98%

Addressing overdose risk among unstably housed women in San Francisco, California: an examination of potential fentanyl contamination of multiple substances

et al. 2020

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Background: Numerous reports have led to concerns that fentanyl is added to many street drugs as an adulterant, including to stimulants like cocaine and methamphetamine, and could increase risks for negative health outcomes. Methods: We collected information regarding recent substance use through self-report and urine toxicology (confirmed with mass spectrometry) once a month for up to 6 monthly study visits from a probability sample of 245 women in San Francisco with a history of housing instability (2016-2019). We compared the presence of fentanyl metabolites with (1) the presence of metabolites for other substances and (2) self-reported past week substance use. Results: Out of 1050 study visits, fentanyl metabolites were detected 35 times (i.e., at 3% of all study visits and among 19/245, or 8% of all women). In most but not all (91%, or 32/35) of these detected cases, heroin or opioid medication use was self-reported. Among women who reported cocaine or methamphetamine use, but did not use heroin or opioid medication, fentanyl was detected in only 1 of 349 cases (0.3%). In adjusted logistic regression, the presence of fentanyl metabolites was independently associated with (1) presence of opiate, heroin, and benzodiazepine metabolites, and (2) self-reported past week use of heroin and opioid medications. Fentanyl metabolite detection was not independently associated with cocaine or methamphetamine use. Conclusions: The presence of fentanyl metabolites in this population was almost entirely among women who also reported using heroin or opioid pills. These data do not support the hypothesis that fentanyl is being routinely added to stimulants as an adulterant on a large scale in this region.

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Section: Discussionmentioning

confidence: 98%

Addressing overdose risk among unstably housed women in San Francisco, California: an examination of potential fentanyl contamination of multiple substances

et al. 2020

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“…Along with disposals, other micro–level harm reduction outcomes from drug safety testing include reported intentions to lower dosage, to take over an extended time period, to take more care in mixing substances, and to alert friends and acquaintances . Emergent findings also suggest that drug safety testing services may disproportionately attract younger, less experienced and female drug users and that they are more likely to engage positively in harm reduction behaviours afterwards.…”

Section: Drug Safety Testingmentioning

confidence: 99%

“…22 Along with disposals, other micro-level harm reduction outcomes from drug safety testing include reported intentions to lower dosage, to take over an extended time period, to take more care in mixing substances, and to alert friends and acquaintances. 22,30,34,37 Emergent findings also suggest that drug safety testing services may disproportionately attract younger, less experienced and female drug users and that they are more likely to engage positively in harm reduction behaviours afterwards. Conversely, engagement and outcomes may be lower for those with longer histories of drug use, higher scores on sensation seeking scales, previously having engaged with drug treatment services or having witnessed a fatal drugs overdose.…”

Section: What This Study Addsmentioning

confidence: 99%

City checking: Piloting the UK's first community‐based drug safety testing (drug checking) service in 2 city centres

Measham

2020

Brit J Clinical Pharma

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Aims To explore the feasibility of delivering community‐based drug safety testing (drug checking), to trial service design characteristics and to compare with festival‐based testing. Methods In total, 171 substances of concern were submitted on 5 dates at 3 venues in 2 UK cities and tested using up to 6 analytical techniques. Test results and harm reduction advice were distributed directly to over 200 service users through 144 tailored healthcare consultations, to stakeholders, and through early warning systems, media and social media alerts. Results The 171 samples were submitted and identified as MDMA (43.3%), cocaine (12.9%), ketamine (12.9%), various psychedelics submitted by students, and heroin and a synthetic cannabinoid submitted by rough sleeping communities, with 76% of samples' test results as expected. The 144 primary service users identified as 91.7% white, 68.1% male, with an average age of 26.7 years. Reported harm reduction intentions included alerting friends and acquaintances (37.5%), being more careful mixing that substance (35.4%), lowered dosage (27.8%), disposal of further substances (6.9%) and additionally 2.8% handed over further substances for verified destruction. Conclusion Community‐based drug safety testing (drug checking) was piloted for the first time in the UK—within a drugs service, a community centre and a church—with consideration given to meso‐level operational feasibility and micro‐level behavioural outcomes. Service design characteristics such as venue, day of week, prior publicity, service provider, and direct and indirect dissemination of results all may impact on outcomes. Future studies should consider cost–benefit analyses of community and event‐based testing and context‐appropriate macro, meso and micro‐level evaluations.

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“…These findings also have important implications for policy and practice regarding two emerging interventions both in the United States and abroad: the distribution of fentanyl test strips (FTS) to PWUD and the expansion and legalization of supervised consumption spaces (SCS). Both interventions create conditions that enable PWUD to reduce the harms associated with their drug use, and both are supported by emerging or established evidence .…”

mentioning

confidence: 98%

“…This opinion is not grounded in fact. Indeed, all available evidence suggests that PWUD will both utilize FTS and modify their behavior based on the results .…”

mentioning

confidence: 99%

Commentary on Neale et al. (2019): Foregrounding the competency, expertise and rights of people who use drugs

Davis

2019

Addiction

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Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States

Cited by 209 publications

References 50 publications

Addressing overdose risk among unstably housed women in San Francisco, California: an examination of potential fentanyl contamination of multiple substances

Addressing overdose risk among unstably housed women in San Francisco, California: an examination of potential fentanyl contamination of multiple substances

City checking: Piloting the UK's first community‐based drug safety testing (drug checking) service in 2 city centres

Commentary on Neale et al. (2019): Foregrounding the competency, expertise and rights of people who use drugs

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