加拿大不列颠哥伦比亚省的减少伤害场所的使用者中已知的芬太尼使用情况。

Known fentanyl use among clients of harm reduction sites in British Columbia, Canada.

机构信息

School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6C 1A5, Canada; HIV/STI Surveillance Research Centre, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.

出版信息

Int J Drug Policy. 2020 Mar;77:102665. doi: 10.1016/j.drugpo.2020.102665. Epub 2020 Jan 18.

DOI:10.1016/j.drugpo.2020.102665

PMID:31962283

Abstract

BACKGROUND

North America is in the midst of an opioid overdose epidemic and it is commonly suggested that exposure to fentanyl is unknown. Using a provincial survey of harm reduction site clients, we aimed to characterize known and unknown fentanyl use and their correlates among people who use drugs in British Columbia, Canada.

METHODS

We recruited 486 clients who were >18 years old and 316 agreed to provide a urine sample for substance use testing. Reported known fentanyl use was defined as a three-level categorical variable assessing recent (i.e., in the previous three days) fentanyl exposure: (i) known exposure; (ii) unknown exposure; and (iii) no exposure. We also assessed any exposure to fentanyl (Yes vs. No) confirmed by urinalysis. Survey data were summarized using descriptive statistics. Multinomial logistic regression and modified Poisson regression models were built to examine different correlates of exposure to fentanyl.

RESULTS

Median age of the participants was 40 (IQR: 32-49). Out of the 303 eligible participants, 38.7% (117) reported known fentanyl use, 21.7% (66) had unknown fentanyl use, and 39.6% (120) had no recent fentanyl use. In the adjusted multinomial logistic regression model and in comparison with unknown fentanyl use, recent known fentanyl use was significantly associated with self-report of methadone use (aRRR = 3.18), heroin/morphine use (aRRR = 4.40), and crystal meth use (aRRR = 2.95). Moreover, any recent exposure to fentanyl (i.e., positive urine test for fentanyl) was significantly associated with living in urban settings (aPR = 1.49), and self-reporting recent cannabis use (aPR = 0.73), crystal meth (aPR = 1.45), and heroin/morphine use (aPR = 2.48).

CONCLUSION

The landscape of illicit opioid use is changing in BC and more people are using fentanyl knowingly. The increasing prevalence of known fentanyl use is concerning and calls for further investments in public awareness and public policy efforts regarding fentanyl exposure and risks.

摘要

背景

北美正处于阿片类药物过量流行之中，人们普遍认为接触芬太尼的情况尚不清楚。本研究利用对不列颠哥伦比亚省（加拿大）减少伤害场所客户的省级调查，旨在描述在该地区使用药物者中已知和未知的芬太尼使用情况及其相关因素。

方法

我们招募了 486 名年龄大于 18 岁的客户，其中 316 名同意提供尿液样本进行物质使用检测。报告的已知芬太尼使用被定义为评估最近（即过去三天）芬太尼暴露的三分类变量：（i）已知暴露；（ii）未知暴露；和（iii）无暴露。我们还评估了尿液分析确认的任何芬太尼暴露（是/否）。使用描述性统计对调查数据进行总结。建立了多项逻辑回归和修正泊松回归模型，以检验与芬太尼暴露相关的不同因素。

结果

参与者的中位年龄为 40（IQR：32-49）岁。在 303 名符合条件的参与者中，38.7%（117 人）报告了已知芬太尼使用，21.7%（66 人）有未知芬太尼使用，39.6%（120 人）最近无芬太尼使用。在调整后的多项逻辑回归模型中，与未知芬太尼使用相比，最近已知芬太尼使用与报告使用美沙酮（ARRr=3.18）、海洛因/吗啡（ARRr=4.40）和冰毒（ARRr=2.95）显著相关。此外，任何最近接触芬太尼（即芬太尼尿液检测阳性）与居住在城市环境（aPR=1.49）以及报告最近使用大麻（aPR=0.73）、冰毒（aPR=1.45）和海洛因/吗啡（aPR=2.48）显著相关。