British Columbia Centre on Substance Use, Vancouver, Canada.
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
Drug Alcohol Rev. 2021 Sep;40(6):964-973. doi: 10.1111/dar.13261. Epub 2021 Feb 18.
Illicitly manufactured fentanyl continues to fuel the opioid overdose crisis throughout the USA and Canada. However, little is known about factors associated with knowingly or unknowingly using fentanyl. Therefore, we sought to identify the prevalence and correlates of suspected/known and unknown exposure to fentanyl (excluding the prescribed one) among people who inject drugs (PWID), including associated overdose risks.
Data were derived from three prospective cohort studies of community-recruited people who use drugs in Vancouver, Canada in 2016-2017. Multivariable logistic regression was used to identify correlates of suspected/known exposure (i.e. urine drug screen positive and self-reporting past 3-day exposure) and unknown exposure to fentanyl (i.e. urine drug screen positive and self-reporting no past three-day exposure), respectively.
Among 590 PWID, 296 (50.2%) tested positive for fentanyl. Of those, 143 (48.3%) had suspected/known and 153 (51.7%) had unknown exposure to fentanyl. In multivariable analyses, using supervised injection sites and possessing naloxone were associated with both suspected/known and unknown exposure (all P < 0.05). Injecting drugs alone (adjusted odds ratio 3.26; 95% confidence interval: 1.72-6.16) was associated with known exposure, but not with unknown exposure.
We found a high prevalence of fentanyl exposure in our sample of PWID, with one half of those exposed consuming fentanyl unknowingly. While those exposed to fentanyl appeared more likely to utilise some overdose prevention services, PWID with suspected/known fentanyl exposure were more likely to inject alone, indicating a need for additional overdose prevention efforts for this group.
非法制造的芬太尼继续在美国和加拿大引发阿片类药物过量危机。然而，人们对与明知或不知觉使用芬太尼相关的因素知之甚少。因此，我们试图确定注射吸毒者（PWID）中疑似/已知和未知的芬太尼暴露（不包括规定剂量的芬太尼）的流行率和相关因素，包括相关的过量风险。
数据来自于 2016-2017 年在加拿大温哥华进行的三项针对社区招募的吸毒者的前瞻性队列研究。多变量逻辑回归用于确定疑似/已知暴露（即尿液药物筛查阳性和报告过去 3 天暴露）和未知芬太尼暴露（即尿液药物筛查阳性和报告过去 3 天无暴露）的相关因素。
在 590 名 PWID 中，有 296 人（50.2%）芬太尼检测呈阳性。其中，143 人（48.3%）有疑似/已知暴露，153 人（51.7%）有未知暴露。在多变量分析中，使用监督注射点和拥有纳洛酮与疑似/已知和未知暴露均相关（均 P<0.05）。单独注射毒品（调整后的优势比 3.26；95%置信区间：1.72-6.16）与已知暴露相关，但与未知暴露无关。
我们发现我们的 PWID 样本中芬太尼暴露的流行率很高，其中一半暴露者不知情地摄入了芬太尼。虽然接触芬太尼的人似乎更有可能使用一些过量预防服务，但有疑似/已知芬太尼暴露的 PWID 更有可能单独注射，这表明需要为这一群体提供额外的过量预防措施。
