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

Take-home drug checking as a novel harm reduction strategy in British Columbia, Canada.

BACKGROUND: Drug checking is a harm reduction strategy used to identify components of illicitly obtained drugs, including adulterants, to prevent overdose. This study evaluated the distribution of take-home fentanyl test strips to people who use drugs (PWUD) in British Columbia, Canada. The primary aim was to assess if the detection of fentanyl in opioid samples was concordant between a take-home model and testing by trained drug checking staff. METHODS: Take-home fentanyl test strips were distributed at ten sites providing drug checking services from April to July 2019. The fentanyl positivity of the aggregate take-home and on-site drug checking groups were compared by class of substance tested. An administered survey assessed acceptability and behaviour change. RESULTS: 1680 take-home results were obtained from 218 unique participants; 68% of samples (n=1142) were identified as opioids and 23% (n=382) were stimulant samples. During this period, 852 samples were tested using on-site drug checking. The fentanyl positivity of opioid samples was 90.0% for take-home samples and 89.1% for on-site samples (Difference 0.8% (95% CI -2.3% to 3.9%)). These results were not affected by previous experience with test strips. Fentanyl positivity of stimulants in the take-home group was higher than on-site (24.7% vs. 3.2%), but the study was underpowered to conduct statistical analysis on this sub-group. When fentanyl was detected, 27% of individuals reported behaviour change that was considered safer/positive. Greater than 95% of participants stated they would use fentanyl test strips again. CONCLUSIONS: Take-home fentanyl test strips used by PWUD on opioid samples can provide similar results to formal drug checking services and are a viable addition to existing overdose prevention strategies. Use of this strategy for detection of fentanyl in stimulant samples requires further evaluation. This intervention was well accepted and in some participants was associated with positive behaviour change

Factors associated with drug checking service utilization among people who use drugs in a Canadian setting

Background: The United States and Canada are amidst an opioid overdose crisis, with the Canadian province of British Columbia (BC) among the hardest hit. In response, drug checking services (DCS) have been introduced in this setting as a novel pilot harm reduction intervention though little is known about usage rates. Therefore, we sought to identify factors associated with drug checking uptake among people who use drugs (PWUD) in Vancouver, BC. Methods: Data were derived from three ongoing prospective cohort studies of PWUD in Vancouver between June and November 2018. Multivariable logistic regression was used to determine factors associated with self-reported DCS utilization in the past 6 months among participants at high risk of fentanyl exposure (i.e., those self-reporting illicit opioid use or testing positive for fentanyl via urine drug screen). Results: Among 828 eligible participants, including 451 (55%) males, 176 (21%) reported recent use of DCS. In multivariable analyses, factors significantly associated with DCS utilization included: homelessness (Adjusted Odds Ratio [AOR] 1.47; 95% Confidence Interval [CI] 1.01–2.13) and involvement in drug dealing (AOR 1.59; 95% CI 1.05–2.39). Conclusions: In our sample of PWUD, uptake of DCS was low, although those who were homeless, a sub-population known to be at a heightened risk of overdose, were more likely to use the services. Those involved in drug dealing were also more likely to use the services, which may imply potential for improving drug market safety. Further evaluation of drug checking is warranted.Medicine, Faculty ofOther UBCNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult