Monitoring for fentanyl within Australian supervised injecting facilities: Findings from feasibility testing of novel methods and collaborative workshops.

Nielsen, S; Barratt, M; Hiley, S; Bartlett, M; Latimer, J; Jauncey, M; Roux, C; Morelato, M; Clark, N; Kowalski, M; Gilbert, M; Francia, L; Shipton, A; Gerostamoulos, D; Glowacki, L; Lam, T

Monitoring for fentanyl within Australian supervised injecting facilities: Findings from feasibility testing of novel methods and collaborative workshops.

Nielsen, S Barratt, M Hiley, S Bartlett, M Latimer, J Jauncey, M Roux, C

Morelato, M

Clark, N Kowalski, M Gilbert, M Francia, L Shipton, A Gerostamoulos, D Glowacki, L Lam, T

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Publisher:: ELSEVIER
Publication Type:: Journal Article
Citation:: Int J Drug Policy, 2023, 115, pp. 104015
Issue Date:: 2023-05

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Field	Value	Language
dc.contributor.author	Nielsen, S
dc.contributor.author	Barratt, M
dc.contributor.author	Hiley, S
dc.contributor.author	Bartlett, M
dc.contributor.author	Latimer, J
dc.contributor.author	Jauncey, M
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	Clark, N
dc.contributor.author	Kowalski, M
dc.contributor.author	Gilbert, M
dc.contributor.author	Francia, L
dc.contributor.author	Shipton, A
dc.contributor.author	Gerostamoulos, D
dc.contributor.author	Glowacki, L
dc.contributor.author	Lam, T
dc.date.accessioned	2024-01-31T03:28:48Z
dc.date.available	2023-03-18
dc.date.available	2024-01-31T03:28:48Z
dc.date.issued	2023-05
dc.identifier.citation	Int J Drug Policy, 2023, 115, pp. 104015
dc.identifier.issn	0955-3959
dc.identifier.issn	1873-4758
dc.identifier.uri	http://hdl.handle.net/10453/175121
dc.description.abstract	BACKGROUND: Australia is yet to see widespread fentanyl-contaminated heroin, despite the established presence of fentanyl in other countries. International mortality trends alongside a local cluster of fentanyl-related deaths prompted interest in developing methods to monitor for fentanyl and other potentially harmful novel psychoactive substances (NPS) in Australia. METHODS: We tested novel methods to monitor for fentanyl and other NPS. From 2017-2021, clients from supervised injecting facilities (SIFs) in Melbourne and Sydney, Australia, contributed urine screens (UDS) with BTNX Rapid Response™ fentanyl test strips (FTS) paired with surveys, and injecting equipment associated with opioid overdoses for laboratory analysis. A single site piloted drug checking using FTS with laboratory confirmation. Two workshops were conducted with SIF staff, content experts and people with lived experience to determine how results can inform practices within SIFs. RESULTS: Of the 911 UDS with FTS conducted, less than 1% (n=8) yielded positive results that were not explained by self-reported pharmaceutical fentanyl use, with two laboratory confirmed fentanyl positive results. Injecting equipment from 59 overdoses was tested and neither fentanyl nor other NPS were identified. Drug checking with FTS (n=34) indicated the presence of fentanyl on three tests. Two specimens were subsequently sent for laboratory testing and classified as false positives as the presence of fentanyl was not confirmed. Workshop participants (n=21) felt routine monitoring with FTS currently had limited value. A process for using pre-defined signals to trigger surveillance was developed. CONCLUSION: The high false positive rates with FTS, relative to the small number of positive results and potential for them to undermine confidence in FTS emphasised the need for confirmatory testing. The role of routine surveillance was unclear within the current low-fentanyl context, however, a process was developed to upscale testing should signals of increased fentanyl prevalence in the Australian heroin market emerge.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	ELSEVIER
dc.relation	Commonwealth Department of Health and Aged CareNCR3SF16
dc.relation.ispartof	Int J Drug Policy
dc.relation.isbasedon	10.1016/j.drugpo.2023.104015
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	11 Medical and Health Sciences, 16 Studies in Human Society, 17 Psychology and Cognitive Sciences
dc.subject.classification	Substance Abuse
dc.subject.classification	4206 Public health
dc.subject.classification	4407 Policy and administration
dc.subject.mesh	Humans
dc.subject.mesh	Fentanyl
dc.subject.mesh	Heroin
dc.subject.mesh	Needle-Exchange Programs
dc.subject.mesh	Feasibility Studies
dc.subject.mesh	Australia
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Drug Overdose
dc.subject.mesh	Humans
dc.subject.mesh	Heroin
dc.subject.mesh	Fentanyl
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Feasibility Studies
dc.subject.mesh	Needle-Exchange Programs
dc.subject.mesh	Australia
dc.subject.mesh	Drug Overdose
dc.subject.mesh	Humans
dc.subject.mesh	Fentanyl
dc.subject.mesh	Heroin
dc.subject.mesh	Needle-Exchange Programs
dc.subject.mesh	Feasibility Studies
dc.subject.mesh	Australia
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Drug Overdose
dc.title	Monitoring for fentanyl within Australian supervised injecting facilities: Findings from feasibility testing of novel methods and collaborative workshops.
dc.type	Journal Article
utslib.citation.volume	115
utslib.location.activity	Netherlands
utslib.for	11 Medical and Health Sciences
utslib.for	16 Studies in Human Society
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	closed_access	*
dc.date.updated	2024-01-31T03:28:47Z
pubs.publication-status	Published
pubs.volume	115

Abstract:

BACKGROUND: Australia is yet to see widespread fentanyl-contaminated heroin, despite the established presence of fentanyl in other countries. International mortality trends alongside a local cluster of fentanyl-related deaths prompted interest in developing methods to monitor for fentanyl and other potentially harmful novel psychoactive substances (NPS) in Australia. METHODS: We tested novel methods to monitor for fentanyl and other NPS. From 2017-2021, clients from supervised injecting facilities (SIFs) in Melbourne and Sydney, Australia, contributed urine screens (UDS) with BTNX Rapid Response™ fentanyl test strips (FTS) paired with surveys, and injecting equipment associated with opioid overdoses for laboratory analysis. A single site piloted drug checking using FTS with laboratory confirmation. Two workshops were conducted with SIF staff, content experts and people with lived experience to determine how results can inform practices within SIFs. RESULTS: Of the 911 UDS with FTS conducted, less than 1% (n=8) yielded positive results that were not explained by self-reported pharmaceutical fentanyl use, with two laboratory confirmed fentanyl positive results. Injecting equipment from 59 overdoses was tested and neither fentanyl nor other NPS were identified. Drug checking with FTS (n=34) indicated the presence of fentanyl on three tests. Two specimens were subsequently sent for laboratory testing and classified as false positives as the presence of fentanyl was not confirmed. Workshop participants (n=21) felt routine monitoring with FTS currently had limited value. A process for using pre-defined signals to trigger surveillance was developed. CONCLUSION: The high false positive rates with FTS, relative to the small number of positive results and potential for them to undermine confidence in FTS emphasised the need for confirmatory testing. The role of routine surveillance was unclear within the current low-fentanyl context, however, a process was developed to upscale testing should signals of increased fentanyl prevalence in the Australian heroin market emerge.

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http://hdl.handle.net/10453/175121