Why the FUSS (Fentanyl Urine Screen Study)? A cross-sectional survey to characterize an emerging threat to people who use drugs in British Columbia, Canada

Abstract

BackgroundFentanyl-detected illicit drug overdose deaths in British Columbia (BC) recently increased dramatically from 13 deaths in 2012 to 90 deaths in 2014, signaling an emerging public health concern. Illicit fentanyl is sold as pills or powders, often mixed with other substances like heroin or oxycodone; reports from coroners suggested that fentanyl was frequently taken unknowingly by people who use drugs. This study aimed to assess the prevalence and characteristics of fentanyl use among clients accessing harm reduction (HR) services in BC.MethodsParticipants attending HR services at 17 sites across BC were invited to complete an anonymous questionnaire describing drugs they have used within the last 3 days and provide a urine sample to test for fentanyl. Data from eligible participants were analyzed using descriptive, bivariate, and multivariate statistical methods.ResultsSurveys from 17 HR sites were received, resulting in analysis of responses from 242 eligible participants. Most participants used multiple substances (median = 3), with crystal meth (59 %) and heroin (52 %) use most frequently reported. Seventy participants (29 %) tested positive for fentanyl, 73 % of whom did not report using fentanyl. Controlling for age, gender, and health authority, reported use of fentanyl (odds ratio (OR) = 6.13, 95 % confidence interval (CI) = [2.52, 15.78], p < 0.001) and crystal methamphetamine (OR = 3.82, 95 % CI = [1.79, 8.63], p < 0.001) use were significantly associated with fentanyl detection.ConclusionsThe proportion of those testing positive who did not report knowingly using fentanyl represents a considerable public health concern. The risk of overdose among this vulnerable population highlights the need for targeted HR strategies, such as increased accessibility to naloxone, overdose education, and urine screens.

Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically

“…Of major public health concern is our finding that the majority of participants who reported FCH exposure had used it without knowing that their heroin was contaminated with fentanyl. To inform public health efforts that address FCH, future research should examine whether fentanyl contamination can be reliably identified prior to consumption (using rapid tests, for example) (Amlani et al, 2015). …”

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

“…By comparison, when used intravenously, fentanyl can cause life-threatening respiratory depression within two minutes (Green & Gilbert, 2016). The rapid onset of action and remarkable potency of fentanyl and its analogues can lead to dramatic central nervous system depression (Amlani et al, 2015) as well as potential chest wall rigidity (Burns, DeRienz, Baker, Casavant, & Spiller, 2016), that may further complicate overdose response.…”

“…People who use opioids may prefer to use fentanyl as it is highly lipid-soluble, thus rapid-acting, and 40 times more potent at the opioid receptor than heroin, which results in fast onset euphoria and pain relief. Many PWID describe the experience as like heroin, but more intense (Amlani et al, 2015; Ciccarone, Ondocsin, & Mars, 2017; Macmadu, Carroll, Hadland, Green, & Marshall, 2017). Like heroin, fentanyl has a half-life of approximately 3-7 hours (Trescot, Datta, Lee, & Hansen, 2008), however, the duration of action of fentanyl is briefer, only 30-60 minutes for an intravenous injection, compared to 4-5 hours for heroin.…”

Misuse of Novel Synthetic Opioids: A Deadly New Trend

“…At present, IMF and NSO are causing an alarming spike in overdose deaths. This increase in fatalities seems partially due to the fact that many users are unknowingly consuming these compounds as adulterants in products sold as heroin, or as counterfeit pain killers (Amlani et al, 2015; DEA, 2016b). It is estimated that a single kilogram of NSO can be used to manufacture hundreds of thousands of counterfeit prescription tablets, which can produce millions of dollars in revenue for traffickers (DEA, 2016b).…”