Fentanyl self-testing outside supervised injection settings to prevent opioid overdose: Do we know enough to promote it?

Since 2013, North America has experienced a sharp increase in unintentional fatal overdoses: fentanyl, and its analogues, are believed to be primarily responsible. Currently, the most practical means for people who use drugs (PWUD) to avoid or mitigate risk of fentanyl-related overdose is to use drugs in the presence of someone who is in possession of, and experienced using, naloxone. Self-test strips which detect fentanyl, and some of its analogues, have been developed for off-label use allowing PWUD to test their drugs prior to consumption. We review the evidence on the off-label sensitivity and specificity of fentanyl test strips, and query whether the accuracy of fentanyl test strips might be mediated according to situated practices of use. We draw attention to the weak research evidence informing the use of fentanyl self-testing strips

Carbon dioxide and methane fluxes and organic carbon accumulation in old field and northern temperate forest plantation soils

Carbon dioxide (CO2) and methane (CH4) fluxes from the soil surface, and concentrations within the soil profile, were measured between June 1998 and Sept. 1999 at four adjacent forest plantations and an old field in Nepean, Ontario. The objectives of this study were to quantify seasonal CO2 and CH4 fluxes from the soil surface and within the soil profile to determine the effect of soil moisture and temperature, and forest age and species on the exchange, and establish a chronosequence of organic carbon accumulation in the forest plantations and the old field soils.Dynamic and static chamber techniques were used to measure surface fluxes of CO2 and CH4, respectively, and soil gas concentrations were sampled with probes. In the old field and forest plantations, surface soil CO2 flux ranged from 2.9 to 27 g CO2 m-2 d-1 and 2.0 to 39 g CO2 m -2 d-1 respectively. Significant differences due to age and species of plantation were observed. Seasonal variations in CO2 efflux from the soil surface and within the soil profile were related to variation in soil temperature and moisture. Uptake of CH4 was observed at all sites and there was no significant differences in flux due to vegetation type or age. Maximum rate of CH4 consumption was 6.3 mg CH4 m-2 d-1. Methane uptake was positively related to soil moisture conditions.The carbon content of the soil increased in all sites following the establishment of vegetation on sandy parent material. Carbon content was greatest in the upper soil profile. Rates of carbon accumulation ranged from 109 to 426 g m-2 y-1. Soil carbon increased with increasing age of plantation during the first 30 years following the establishment of vegetation on parent material, but declined as the forest plantation matured

Rigidity, dyskinesia and other atypical overdose presentations observed at a supervised injection site, Vancouver, Canada

Objective: In midst of the overdose crisis, the clinical features of opioid overdoses seem to be changing. Understanding of the adverse effects of synthetic opioids such as fentanyl is currently limited to clinical settings. Insite, a supervised injection site in Vancouver, Canada, provides an opportunity to better understand illicit drug overdose presentations. Methods: A review of clinical records at Insite for October 2016 to April 2017 was undertaken to quantify atypical overdose presentations. Overdose reports were reviewed for the number of atypical opioid overdose presentations, temporal trends over the study period, concurrent symptoms, and interventions employed by staff. Results: Insite staff responded to 1581 overdoses during the study period, including 497 (31.4%) that did not fit a typical presentation for opioid overdoses. Of these, 485 fit into five categories of atypical features: muscle rigidity, dyskinesia, slow or irregular heart rate, confusion, and anisocoria. Muscle rigidity was the most common atypical presentation, observed in 240 (15.2%) of the overdose cases, followed by dyskinesia, observed in 150 (9.2%). Slow or irregular heart rate was observed in 69 (4.4%) cases, confusion in 24 (1.5%), and anisocoria in 2 (0.1%) of overall overdose cases. Discussion: The similarity of atypical overdose cases at Insite with anesthesiology case reports supports the understanding that the illicit drug supply is contaminated by fentanyl and other synthetic opioids. Atypical overdose presentations can affect clinical overdose response. The experience at Insite highlights the potential for supervised consumption sites to be innovative spaces for community learning and knowledge translation.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult

WORKING TOGETHER: THE ROLE OF EXTERNAL AGENTS IN THE DEVELOPMENT OF AGRICULTURE-BASED INDUSTRIES

Agribusiness,

Evaluation of a fentanyl drug checking service for clients of a supervised injection facility, Vancouver, Canada

Background: British Columbia, Canada, is experiencing a public health emergency related to opioid overdoses driven by consumption of street drugs contaminated with illicitly manufactured fentanyl. This cross-sectional study evaluates a drug checking intervention for the clients of a supervised injection facility (SIF) in Vancouver. Methods: Insite is a facility offering supervised injection services in Vancouver’s Downtown East Side, a community with high levels of injection drug use and associated harms, including overdose deaths. During July 7, 2016, to June 21, 2017, Insite clients were offered an opportunity to check their drugs for fentanyl using a test strip designed to test urine for fentanyl. Results of the drug check were recorded along with information including the substance checked, whether the client intended to dispose of the drug or reduce the dose and whether they experienced an overdose. Logistic regression models were constructed to assess the associations between drug checking results and dose reduction or drug disposal. Crude odds ratios (OR) and 95% confidence intervals (CI) were reported. Results: About 1% of the visits to Insite during the study resulted in a drug check. Out of 1411 drug checks conducted by clients, 1121 (79.8%) were positive for fentanyl. Although most tests were conducted post-consumption, following a positive pre-consumption drug check, 36.3% (n = 142) of participants reported planning to reduce their drug dose while only 11.4% (n = 50) planned to dispose of their drug. While the odds of intended dose reduction among those with a positive drug check was significantly higher than those with a negative result (OR = 9.36; 95% CI 4.25–20.65), no association was observed between drug check results and intended drug disposal (OR = 1.60; 95% CI 0.79–3.26). Among all participants, intended dose reduction was associated with significantly lower odds of overdose (OR = 0.41; 95% CI 0.18–0.89). Conclusions: Although only a small proportion of visits resulted in a drug check, a high proportion (~ 80%) of the drugs checked were contaminated with fentanyl. Drug checking at harm reduction facilities such as SIFs might be a feasible intervention that could contribute to preventing overdoses in the context of the current overdose emergency.Medicine, Faculty ofOther UBCMedicine, Department ofPopulation and Public Health (SPPH), School ofReviewedFacult

Is expected substance type associated with timing of drug checking service utilization?: A cross-sectional study

Background Drug checking is a harm reduction intervention aiming to reduce substance use-related risks by improving drug user knowledge of the composition of unregulated drugs. With increasing fears of fentanyl adulteration in unregulated drugs, this study sought to examine whether the expected type of drug checked (stimulant vs. opioid) was associated with timing of drug checking service utilization (pre-consumption vs. post-consumption). Methods Data were derived from drug checking sites in British Columbia between October 31, 2017 and December 31, 2019. Pearson’s Chi-square test was used to examine the relationship between expected sample type (stimulant vs. opioid) and timing of service utilization. Odds ratios (OR) were calculated to assess the strength of this relationship. The Mantel–Haenszel (MH) test was used to adjust for service location. Results A total of 3561 unique stimulant and opioid samples were eligible for inclusion, including 691 (19.40%) stimulant samples; and 2222 (62.40%) samples that were tested pre-consumption. Results indicated a positive association between testing stimulant samples and testing pre-consumption (OR = 1.45; 95% CI 1.21–1.73). Regions outside of the epicenter of the province’s drug scene showed a stronger association with testing pre-consumption (ORMH = 2.33; 95% CI 1.51–3.56) than inside the epicenter (ORMH = 1.33; 95% CI 1.09–1.63). Conclusion Stimulant samples were more likely to be checked pre-consumption as compared with opioid samples, and stimulant samples were more likely to be tested pre-consumption in regions outside the epicenter of the province’s drug scene. This pattern may reflect a concern for fentanyl-adulterated stimulant drugs.Medicine, Faculty ofMedicine, Department ofPopulation and Public Health (SPPH), School ofReviewedFacultyResearche

Implementation opportunities and challenges to piloting a community-based drug-checking intervention for sexual and gender minority men in Vancouver, Canada: a qualitative study

Abstract Background In response to the overdose crisis, a collaborative group of two community-based organizations, a health authority and a research institute in Vancouver, Canada, implemented a pilot community-based drug checking (CBDC) intervention for sexual and gender minority (SGM) men. This study identified key factors that influenced the implementation of the CBDC intervention, including opportunities and challenges. Methods We conducted semi-structured interviews with seven pertinent parties involved in the CBDC, including policymakers, researchers and representatives from community-based organizations. These interviews were coded and analyzed using domains and constructs of the Consolidated Framework for Implementation Research. Results While drug-related stigma was identified as a challenge to deliver drug checking services, participants described the context of the overdose crisis as a key facilitator to engage collaboration between relevant organizations (e.g., health authorities, medical health officers, community organizations) to design, resource and implement the CBDC intervention. The implementation of the CBDC intervention was also influenced by SGM-specific needs and resources (e.g., lack of information about the drug supply). The high level of interest of SGM organizations in providing harm reduction services combined with the need to expand drug checking into community spaces represented two key opportunities for the CBDC intervention. Here, SGM organizations were recognized as valued partners that fostered a broader culture of harm reduction. Participants’ emphasis that knowing the composition of one’s drugs is a “right to know”, particularly in the context of a highly contaminated illicit drug market, emerged as a key implementation factor. Lastly, participants emphasized the importance of involving SGM community groups at all stages of the implementation process to ensure that the CBDC intervention is appropriately tailored to SGM men. Conclusions The context of the overdose crisis and the involvement of SGM organizations were key facilitators to the implementation of a drug checking intervention in SGM community spaces. This study offers contextualized understandings about how SGM knowledge and experiences can contribute to implement tailored drug checking interventions

Characterizing the presence of fentanyl analogues in the unregulated drug supply in British Columbia, Canada

Background: The emergence of fentanyl and its analogues (e.g., carfentanil) have contributed to a rise in overdose-related mortality. The objective of this study was to describe samples containing fentanyl analogues appearing in the unregulated drug supply of British Columbia (BC), Canada. Methods: Point-of-care drug checking data, using a combination of fentanyl immunoassay strips and Fourier-transform infrared spectroscopy (FTIR), were collected at harm reduction sites in BC between 2017 and 2021. A subset of samples were sent for confirmatory analysis using quantitative nuclear resonance spectroscopy, gas chromatography-mass spectrometry, and/or liquid chromatography-mass spectrometry. Results: A total of 22916 samples were tested using point of care technologies, with 43% testing positive for fentanyl via fentanyl test strips. 1467 were sent for confirmatory analysis, and of these 854 (58%) tested positive for fentanyl via fentanyl test strips and 84 (6%) contained at least one fentanyl analogue, including: carfentanil (n=61), acetyl fentanyl (n=15), furanyl fentanyl (n=8) and cyclopropyl fentanyl (n=5). Fourteen (16%) samples containing a fentanyl analogue tested negative via fentanyl immunoassay strips and fentanyl was also not detected using FTIR. Fentanyl analogues in all fourteen samples were identified in trace amounts via confirmatory analysis. Conclusion: Fentanyl analogues were present in the unregulated drug supply and while the risk profiles are known for some, not all are well characterized. These findings underscore the importance of drug checking initiatives for monitoring the unregulated drug market.Medicine, Faculty ofNon UBCMedicine, Department ofPathology and Laboratory Medicine, Department ofPopulation and Public Health (SPPH), School ofUnreviewedFacultyResearche