February 01, 2018
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Fentanyl use increasing rapidly in high-risk populations

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William G. Honer

During a 5-month period, researchers found that fentanyl was detected in 39% of urine samples taken from an impoverished neighborhood in Canada, and that the probability of fentanyl detection doubled each month.

“The Province of British Columbia, Canada, has experienced a tremendous increase in the number of opioid related overdoses and deaths,” William G. Honer, MD, FRCPC, FCAHS Jack Bell Chair in schizophrenia, professor and head, department of psychiatry, University of British Columbia, told Healio Psychiatry. “Toxicology studies of deaths, and examination of seized drugs indicate fentanyl is the major cause. These indirect measures suggest widespread exposure to fentanyl in opioid users; however direct studies of the extent of exposure of opioid users to fentanyl in the community are lacking.”

Researchers assessed data from a health outcomes study of 237 people living in an impoverished Vancouver neighborhood, as well as overall overdose deaths and first responder calls, from Mar. 1 to July 31, 2017. Participants attended monthly visits and reported use of prescribed and nonprescribed drugs — including fentanyl, buprenorphine, codeine, heroin, hydromorphone, methadone, morphine, and oxycodone — during the week before. Jones and colleagues tested 595 urine samples for fentanyl/norfentanyl, morphine, heroin, codeine and methadone to determine the link between detection and reported opioid use in the previous week.

In total, 78% of participants were men and many were marginally housed or street homeless. Overdose deaths and first responder calls increased drastically from March to April. Almost half of participants reported using injection drugs in the past week. During the 5-month study period, 38% of participants reported nonprescribed opioid use, 55% of whom were prescribed opioid agonist therapy, such as hydromorphone, methadone, buprenorphine, morphine or heroin.

The researchers detected fentanyl in 39% of analyzed urine samples, 52% of which came from participants prescribed opioid agonist treatment. Among 91 participants who reported nonprescribed opioid use, 83 (91%) had at least one fentanyl-positive urine sample. Analysis also showed opiates were present in 34% of urine samples. Furthermore, the probability of detecting fentanyl doubled each month (OR, 2.28; P < .001). Although opiate detection decreased over time (OR, 0.32; P = .003), fentanyl detection probability increased at a faster rate over time (OR, 2.34; P = .03) among self-reported nonprescribed opioid users. By July, all urine samples from nonprescribed opioid users were fentanyl-positive.

“Because fentanyl is more potent than opioid agonist therapies, users in treatment also exposed to fentanyl may also develop increased tolerance, possibly rendering the agonist therapies less effective,” Honer said. “Research can contribute to the opioid crisis by providing local information to guide development of personalized care. Establishing and maintaining studies such as ours could serve a ‘sentinel’ function to allow early identification of risk, as new synthetic drugs become available in diverse communities.” – by Savannah Demko

Disclosures: Honer reports personal fees from AlphaSights, Eli Lilly, Lundbeck and Otsuka. The authors report no other relevant financial disclosures.