Kirk Mia Rae, McCarthy May, Reyes Andres, Chase Benjamin, Anderson Jessica, Harding Robert W, Fiuty Phillip, Page Kimberly, Wagner Karla D
School of Public Health, University of Nevada, Reno, NV, USA.
Health Sciences Center, University of New Mexico, Albuquerque, NM, USA.
Clin Toxicol (Phila). 2024 Sep 4:1-7. doi: 10.1080/15563650.2024.2391011.
Co-use of stimulants and opioids is often deliberate. However, the possibility remains that some people are unintentionally consuming fentanyl. To advance understanding of overdose risk, we examined the rate of concordance between self-reported fentanyl use and corresponding urine toxicology screen results.
Between August 2022-August 2023, 411 participants (adults who reported any non-medical drug use in the past three months) in Nevada and New Mexico completed a cross-sectional survey, of whom 64% ( = 270; the analytical sample) also completed a urine toxicology screen, which detects fentanyl use in the past three days. Positive predictive value, negative predictive value, sensitivity, and specificity were calculated using self-reported past three-day fentanyl use (yes/no) and urine toxicology screen results for the presence of fentanyl (positive/negative).
Of the 270 participants who provided a urine sample, 268 are included in the descriptive statistics (two with inconclusive urine toxicology screen results were excluded). Of the 268 participants, 146 (54.5%) had a fentanyl-positive urine toxicology screen result, 122 (45.5%) had a fentanyl-negative urine toxicology screen result, 137 (51.1%) reported past three-day fentanyl use, and 130 (48.5%) reported no past three-day fentanyl use. Only 6.9% of those with a fentanyl-positive urine toxicology screen did not report recent fentanyl use. The sensitivity of self-reported fentanyl use was 93%, specificity was 97%, positive predictive value was 97%, and negative predictive value was 92%.
The rate of unanticipated exposure to fentanyl (that is, positive urine screen and negative self-report) in this sample was low, at 6.9%. This runs counter to the national narrative that there is widespread unknown contamination of fentanyl in the drug supply.
Future research is needed to further explore how people who use multiple substances interpret their overdose risk and what harm reduction methods they employ.
兴奋剂和阿片类药物的同时使用往往是故意的。然而，仍有可能一些人在无意中摄入了芬太尼。为了增进对过量用药风险的理解，我们研究了自我报告的芬太尼使用情况与相应尿液毒理学筛查结果之间的一致性率。
在2022年8月至2023年8月期间，内华达州和新墨西哥州的411名参与者（过去三个月报告有任何非医疗性药物使用的成年人）完成了一项横断面调查，其中64%（n = 270；分析样本）还完成了尿液毒理学筛查，该筛查可检测过去三天内是否使用了芬太尼。使用自我报告的过去三天内芬太尼使用情况（是/否）和尿液毒理学筛查中芬太尼存在情况（阳性/阴性）的结果计算阳性预测值、阴性预测值、敏感性和特异性。
在提供尿液样本的270名参与者中，268名被纳入描述性统计（排除了两名尿液毒理学筛查结果不确定的参与者）。在这268名参与者中，146名（54.5%）尿液毒理学筛查结果为芬太尼阳性，122名（45.5%）尿液毒理学筛查结果为芬太尼阴性，137名（51.1%）报告过去三天使用过芬太尼，130名（48.5%）报告过去三天未使用过芬太尼。尿液毒理学筛查结果为芬太尼阳性的参与者中，只有6.9%没有报告近期使用芬太尼。自我报告的芬太尼使用情况的敏感性为93%，特异性为97%，阳性预测值为97%，阴性预测值为92%。
该样本中意外接触芬太尼的比例（即尿液筛查阳性但自我报告阴性）较低，为6.9%。这与全国性说法相悖，即药物供应中存在广泛的未知芬太尼污染。
未来需要进一步研究使用多种物质的人如何解读他们的过量用药风险以及他们采用了哪些减少伤害的方法。
