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

Harm Reduction Journal

Jane A. Buxton²  Erica Tsang²  Geetha Raghukumar²  Noren Khamis²  Geoff McKee¹  Ashraf Amlani³ 

[1] School of Public and Population Health, University of British Columbia, Vancouver, Canada;Faculty of Medicine, University of British Columbia, Vancouver, Canada;British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver BC V5Z 4R4, Canada

关键词: Opioids;    Overdose;    Fentanyl;    People who use drugs;    Survey;   

Others  :  1233423
DOI  :  10.1186/s12954-015-0088-4

 received in 2015-09-10, accepted in 2015-11-08,  发布年份 2015

【 摘 要 】

Background

Fentanyl-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.

Methods

Participants 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.

Results

Surveys 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.

Conclusions

The 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.

【 授权许可】

   
2015 Amlani et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]British Columbia Coroners Service. Information bulletin: BC Coroners Service warns of deaths related to illicit fentanyl use. 2014. http://www.pssg.gov.bc.ca/coroners/reports/docs/2014JAG0150-000766.pdf. Accessed 27 Oct 2015.
• [2]Canadian Centre on Substance Abuse, Canadian Community Epidemiology Network on Drug Use. CCENDU drug alert—increasing availability of counterfeit oxycodone tablets containing fentanyl. 2014. http://www.ccsa.ca/Resource%20Library/CCSA-CCENDU-Oxycontin-Fentanyl-Alert-2014-en.pdf Library/CCSA-CCENDU-Oxycontin-Fentanyl-Alert-2014-en.pdf. Accessed Oct 27, 2015.
• [3]Poklis A. Fentanyl: A Review for Clinical and Analytical Toxicologists. Clin Toxicol [Internet]. Informa UK Ltd UK; 1995;33(5):439–47. http://www.tandfonline.com/doi/abs/10.3109/15563659509013752?journalCode=ictx19#.VkU0cHGjN8E Accessed 11 May 2015.
• [4]Hess R, Stiebler G, Herz A. Pharmacokinetics of fentanyl in man and the rabbit. Eur J Clin Pharmacol [Internet]. 1972; 4(3):137-41.
• [5]Jafari S, Buxton JA, Joe R. Rising fentanyl-related overdose deaths in British Columbia. Can J Addict. 2015; 6(1):4-6.
• [6]Martin TL, Woodall KL, McLellan BA. Fentanyl-related deaths in Ontario, Canada: toxicological findings and circumstances of death in 112 cases (2002–2004). J Anal Toxicol. 2006; 30(8):603-10.
• [7]Nonpharmaceutical fentanyl-related deaths—multiple states, April 2005–March 2007. MMWR. 2008; 57(29):793-6.
• [8]Acetyl fentanyl overdose fatalities—Rhode Island, March-May 2013. MMWR Morb Mortal Wkly Rep. 2013; 62(34):703-4.
• [9]Canadian Centre on Substance Abuse. CCENDU bulletin: deaths involving fentanyl in Canada, 2009–2014. Ottawa, ON; 2015.
• [10]Kuo M, Shamsian A, Tzemis D, Buxton JA. A drug use survey among clients of harm reduction sites across British Columbia, Canada, 2012. Harm Reduct J. 2014; 11:13. BioMed Central Full Text
• [11]Silverstein JH, Rieders MF, McMullin M, Schulman S, Zahl K. An analysis of the duration of fentanyl and its metabolites in urine and saliva. Anesth Analg. 1993; 76:618-21.
• [12]BTNX Inc. Rapid response: fentanyl (FYL) test strip (urine) product insert. Markham, ON, Canada; 2013.
• [13]Sorge J, Buxton JA, Amlani A, Ishiguro S. Substance use trends in BC: a survey of harm reduction clients—overall results for British Columbia 2014. 2015.
• [14]Anonymous. Personal Communication. Vancouver; 2015.
• [15]Walsh J. Personal Communication. 2015.
• [16]Stiller RL, Scierka AM, Davis PJ, Ryan Cook D. A brief technical communication: detection of fentanyl in urine. Forensic Sci Int. 1990; 44(1):1-6.
• [17]Communicating drug alerts (CDA)—tips for informing people who use drugs about adverse drug events. 2014.
• [18]Community-based opioid overdose prevention programs providing naloxone—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012; 61(6):101-5.
• [19]Banjo O, Tzemis D, Al-Qutub D, Amlani A, Kesselring S, Buxton JA. A quantitative and qualitative evaluation of the British Columbia Take Home Naloxone program. Can Med Assoc. 2014; 2(3):E153-61.
• [20]A strategic plan for Rhode Island: RI Governor’s Overdose Prevention and Intervention Task Force . 2015 http://www.strategicplanri.org/. Accessed 3 Nov 2015.
• [21]CDC Health Alert Network (HAN): increases in fentanyl drug confiscations and fentanyl-related overdose fatalities. Atlanta, GA; 2015 http://emergency.cdc.gov/han/han00384.asp . Accessed 3 Nov 2015.