Infrequent detection of unintentional fentanyl use via urinalysis among people who regularly inject opioids in Sydney and Melbourne, Australia.

Lam, T; Barratt, MJ; Bartlett, M; Latimer, J; Jauncey, M; Hiley, S; Clark, N; Gerostamoulos, D; Glowacki, L; Roux, C; Morelato, M; Nielsen, S

Infrequent detection of unintentional fentanyl use via urinalysis among people who regularly inject opioids in Sydney and Melbourne, Australia.

Lam, T Barratt, MJ Bartlett, M Latimer, J Jauncey, M Hiley, S Clark, N Gerostamoulos, D Glowacki, L Roux, C

Morelato, M

Nielsen, S

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Addiction, 2022
Issue Date:: 2022-02-07

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Field	Value	Language
dc.contributor.author	Lam, T
dc.contributor.author	Barratt, MJ
dc.contributor.author	Bartlett, M
dc.contributor.author	Latimer, J
dc.contributor.author	Jauncey, M
dc.contributor.author	Hiley, S
dc.contributor.author	Clark, N
dc.contributor.author	Gerostamoulos, D
dc.contributor.author	Glowacki, L
dc.contributor.author	Roux, C https://orcid.org/0000-0003-3610-420X
dc.contributor.author	Morelato, M https://orcid.org/0000-0001-7616-0623
dc.contributor.author	Nielsen, S
dc.date.accessioned	2022-02-15T01:00:25Z
dc.date.available	2022-01-17
dc.date.available	2022-02-15T01:00:25Z
dc.date.issued	2022-02-07
dc.identifier.citation	Addiction, 2022
dc.identifier.issn	0965-2140
dc.identifier.issn	1360-0443
dc.identifier.uri	http://hdl.handle.net/10453/154516
dc.description.abstract	BACKGROUND AND AIM: The current phase of the North American 'opioid crisis' is characterised by illicit fentanyl use; however, the presence of illicit fentanyl in Australia is unknown. This study aimed to monitor unintentional fentanyl consumption in Australia. DESIGN: Rapid Urine Drug Screens (UDS) paired with surveys conducted within Supervised Injecting Facilities (SIFs), and confirmatory laboratory testing. SETTING: Sydney and Melbourne, Australia PARTICIPANTS: Clients who used heroin within the past 2 days (n=911 tests, 2017-2021). Participants were demographically similar to the overall client base (median age 43, 72% male). MEASUREMENTS: UDS were conducted using BTNX Rapid Response™ fentanyl urine strip tests with cross-reactivity to numerous fentanyl analogues. Positive urine samples were analysed using liquid chromatography coupled with tandem mass spectrometry. Surveys covered past 3 day drug use and lifetime report of fentanyl in heroin. FINDINGS: Two percent of participants reported intentional use of fentanyl, mostly through fentanyl patches. Of the 911 rapid UDS conducted, 17 (1.9%) yielded positive results. Eight of these (all from Melbourne) were not explained by survey-reported fentanyl use in the past 3 days. Of these 8 unexplained positives, confirmatory laboratory analysis was conducted on 6, with 4 deemed to be false positives, and 2 confirmed for the presence of fentanyl. This represents the first confirmation of unintended use of fentanyl type substances in this population. CONCLUSION: There is limited evidence of unintentional fentanyl use among people in Sydney and Melbourne, Australia who regularly inject heroin, suggesting that, currently, there is very little illicit fentanyl in Australian drug markets accessed by Supervised Injecting Facilities attendees. This study demonstrates the feasibility of quick onsite testing to cost-effectively screen large samples for fentanyl; however, the high false positive rate emphasises the need for confirmation of positive tests through advanced analytical techniques.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation	Commonwealth Department of HealthNCR3SF16
dc.relation.ispartof	Addiction
dc.relation.isbasedon	10.1111/add.15832
dc.rights	info:eu-repo/semantics/embargoedAccess
dc.subject	11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences
dc.subject.classification	Substance Abuse
dc.title	Infrequent detection of unintentional fentanyl use via urinalysis among people who regularly inject opioids in Sydney and Melbourne, Australia.
dc.type	Journal Article
utslib.location.activity	England
utslib.for	11 Medical and Health Sciences
utslib.for	17 Psychology and Cognitive Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Science
pubs.organisational-group	/University of Technology Sydney/Strength - CFS - Centre for Forensic Science
pubs.organisational-group	/University of Technology Sydney/Faculty of Science/School of Mathematical and Physical Sciences
utslib.copyright.status	open_access	*
utslib.copyright.embargo	2023-02-07T00:00:00+1000Z
dc.date.updated	2022-02-15T01:00:19Z
pubs.publication-status	Published online

Abstract:

BACKGROUND AND AIM: The current phase of the North American 'opioid crisis' is characterised by illicit fentanyl use; however, the presence of illicit fentanyl in Australia is unknown. This study aimed to monitor unintentional fentanyl consumption in Australia. DESIGN: Rapid Urine Drug Screens (UDS) paired with surveys conducted within Supervised Injecting Facilities (SIFs), and confirmatory laboratory testing. SETTING: Sydney and Melbourne, Australia PARTICIPANTS: Clients who used heroin within the past 2 days (n=911 tests, 2017-2021). Participants were demographically similar to the overall client base (median age 43, 72% male). MEASUREMENTS: UDS were conducted using BTNX Rapid Response™ fentanyl urine strip tests with cross-reactivity to numerous fentanyl analogues. Positive urine samples were analysed using liquid chromatography coupled with tandem mass spectrometry. Surveys covered past 3 day drug use and lifetime report of fentanyl in heroin. FINDINGS: Two percent of participants reported intentional use of fentanyl, mostly through fentanyl patches. Of the 911 rapid UDS conducted, 17 (1.9%) yielded positive results. Eight of these (all from Melbourne) were not explained by survey-reported fentanyl use in the past 3 days. Of these 8 unexplained positives, confirmatory laboratory analysis was conducted on 6, with 4 deemed to be false positives, and 2 confirmed for the presence of fentanyl. This represents the first confirmation of unintended use of fentanyl type substances in this population. CONCLUSION: There is limited evidence of unintentional fentanyl use among people in Sydney and Melbourne, Australia who regularly inject heroin, suggesting that, currently, there is very little illicit fentanyl in Australian drug markets accessed by Supervised Injecting Facilities attendees. This study demonstrates the feasibility of quick onsite testing to cost-effectively screen large samples for fentanyl; however, the high false positive rate emphasises the need for confirmation of positive tests through advanced analytical techniques.

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http://hdl.handle.net/10453/154516