The Increasing Prevalence of Fentanyl: A Urinalysis‐Based Study Among Individuals With Opioid Use Disorder in New York City

• Published in: The American journal on addictions 2021-01, Vol.30 (1), p.65-71
• Main Authors: Martinez, Suky, Jones, Jermaine D., Brandt, Laura, Campbell, Aimee N. C., Abbott, Rebecca, Comer, Sandra D.
• Format: Article
• Language: English
• Subjects: Adult; Drug Contamination - statistics & numerical data; Drug Overdose; Drug Users; Female; Fentanyl - urine; Harm Reduction; Humans; Illicit Drugs - analysis; Intention; Male; Middle Aged; Narcotics - analysis; New York City; Opiate Substitution Treatment; Opioid-Related Disorders - therapy; Opioid-Related Disorders - urine; Prevalence; Substance Abuse Detection; Surveys and Questionnaires; Urinalysis
• ISSN: 1055-0496; 1521-0391
• DOI: 10.1111/ajad.13092

Background and Objectives Opioid‐related overdose deaths in North America have increased drastically, partially due to the increased prevalence of illicitly manufactured fentanyl. The current study sought to assess the prevalence and intentionality of fentanyl use among individuals with opioid use disorder (OUD). Methods For this secondary analysis (study 1) we screened a total of 1118 urine samples from 316 participants with OUD from 2016 to 2019. Fentanyl knowledge and intentionality of use were assessed in a separate OUD sample (study 2; N = 33). Results In study 1, 34.6% of all urine samples tested positive for fentanyl. Overall, 149 (47.2%) participants provided more than or equal to one urine sample that tested fentanyl‐positive, and 93 (29.4%) provided more than or equal to two fentanyl‐positive samples. The number of fentanyl‐positive samples, relative to the number of samples tested each year, increased by 330% from year 1 to 3. Study 2 found all participants had pre‐existing knowledge that drugs may be adulterated with fentanyl, yet 67% were surprised by their own fentanyl‐positive test result. Discussion and Conclusions Like previous studies, our data indicate the high prevalence of fentanyl exposure and low perception of fentanyl‐related risk among individuals with OUD, respectively, suggesting that opioid overdose harm reduction efforts may need to focus more on drug users’ understanding of risks related to fentanyl use and adulteration of drugs. Scientific Significance The current studies provide longitudinal data on fentanyl exposure prevalence and risk perception that is uniquely granular by assessing OUD treatment status, and by identifying potential associations between fentanyl exposure with the presence of other drug use and nonfatal overdose. (Am J Addict 2021;30:65–71)