Rapid Change in Fentanyl Prevalence in a Community-Based, High-Risk Sample

Abstract

Planning for the implications of nonprescribed fentanyl use relies on multisource forensic 1,2 or clinical samples. 3,4 Complementing these descriptions, we report a prospective longitudinal study of change in urine fentanyl prevalence in a highrisk, community-based sample. 5Methods | Directly assessed participants were from a health outcomes study of people living in an impoverished neighborhood of Vancouver, Canada. 5 For context, overall over-dose deaths (Vancouver) and first responder calls (Vancouver and neighborhood-specific) were obtained from the British Columbia Coroner's Office and Vancouver Police and Fire statistics for the study period (March 1 to July 31, 2017). Participants attended monthly visits and reported prescribed and nonprescribed drug use during the previous week, including fentanyl, buprenorphine, codeine, heroin, hydromorphone, methadone, morphine, and oxycodone. Participants (N = 237) contributed 595 urine samples that were tested for fentanyl/norfentanyl, opiates (morphine, heroin, and codeine), and methadone using detection strips (BTNX Inc). Agreement between reports and detection was assessed by κ statistic. Repeated measures logistic mixed-

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 .…”

“…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 .…”

“…Jones et al . (2017) collected five monthly urine samples from 237 participants, including individuals who reported nonprescribed opioid use and/or the use of opiate substitution treatments. Nearly all (83 of 91; 91%) participants who reported nonprescribed opioid use (including heroin) submitted at least one fentanyl‐positive urine sample; 82% of these were using fentanyl unknowingly.…”

Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by LC–MS/MS after unintentional overdose

“…As shown in a recent study in Canada, 75% of individuals reporting nonmedical opioid use and denying fentanyl use had their urine test positive for fentanyl [43]. Another study showed that, among patients denying known exposure to fentanyl and seeking opioid withdrawal management, twothirds tested positive for fentanyl in urine [44].…”

Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach

“…On initial assessment, the patient self-reported injecting 200 mg of heroin daily 200 mg of crystal methamphetamine every 3 days. The actual amounts used was difficult to measure given the variability in chemical make-up and potency of heroin and other street drugs in Vancouver, including their adulteration with fentanyl and other contaminants [22,23].…”