Samantha Young1, Kanna Hayashi2, Cameron Grant3, M J Milloy4, Kora DeBeck5, Evan Wood4, Nadia Fairbairn6. 1. British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, British Columbia, V6Z 2A9, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada. 2. British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, British Columbia, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. 3. British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, British Columbia, V6Z 2A9, Canada. 4. British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, British Columbia, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 667-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada. 5. British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, British Columbia, V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada. 6. British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, British Columbia, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 667-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada. Electronic address: bccsu-nf@bccsu.ubc.ca.
Abstract
BACKGROUND: Little is known about the relationship between opioid agonist therapy (OAT) and fentanyl use, specifically. This study aimed to estimate the association between current use of different forms of OAT, including methadone, buprenorphine/naloxone (BUP/NX), slow release oral morphine (SROM), or injectable opioid agonist treatment (iOAT), and the likelihood of a fentanyl-positive urine drug test (UDT) as compared to no OAT. METHODS: Data were obtained from three community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada from December 2016 through November 2018. Using multivariable Generalized Estimating Equations (GEE), we examined the association between current use of each form of OAT, as compared to no OAT, and fentanyl-positive UDT among participants who use opioids. RESULTS: The 915 participants contributed 2112 UDTs over a median of two follow-up visits. The majority of UDTs (74.9 %) were positive for fentanyl. After adjustment for a priori defined confounding factors, compared to no OAT, current use of BUP/NX was associated with lower odds of fentanyl-positive UDT (odds ratio [OR] = 0.36, 95 % confidence interval [CI]: 0.22-0.58) while current use of methadone (OR = 0.84, 95 % CI: 0.65-1.07), iOAT (OR = 1.30, 95 % CI: 0.75-2.28), and SROM (OR = 1.34, 95 % CI: 0.74-2.43) were not. CONCLUSIONS: In this cohort of people who use opioids in Vancouver, only use of BUP/NX was associated with lower odds of fentanyl-positive UDT. Our findings highlight high rates of ongoing fentanyl use despite the use of OAT and support the expansion of BUP/NX for the treatment of people who use fentanyl.
BACKGROUND: Little is known about the relationship between opioid agonist therapy (OAT) and fentanyl use, specifically. This study aimed to estimate the association between current use of different forms of OAT, including methadone, buprenorphine/naloxone (BUP/NX), slow release oral morphine (SROM), or injectable opioid agonist treatment (iOAT), and the likelihood of a fentanyl-positive urine drug test (UDT) as compared to no OAT. METHODS: Data were obtained from three community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada from December 2016 through November 2018. Using multivariable Generalized Estimating Equations (GEE), we examined the association between current use of each form of OAT, as compared to no OAT, and fentanyl-positive UDT among participants who use opioids. RESULTS: The 915 participants contributed 2112 UDTs over a median of two follow-up visits. The majority of UDTs (74.9 %) were positive for fentanyl. After adjustment for a priori defined confounding factors, compared to no OAT, current use of BUP/NX was associated with lower odds of fentanyl-positive UDT (odds ratio [OR] = 0.36, 95 % confidence interval [CI]: 0.22-0.58) while current use of methadone (OR = 0.84, 95 % CI: 0.65-1.07), iOAT (OR = 1.30, 95 % CI: 0.75-2.28), and SROM (OR = 1.34, 95 % CI: 0.74-2.43) were not. CONCLUSIONS: In this cohort of people who use opioids in Vancouver, only use of BUP/NX was associated with lower odds of fentanyl-positive UDT. Our findings highlight high rates of ongoing fentanyl use despite the use of OAT and support the expansion of BUP/NX for the treatment of people who use fentanyl.
Authors: Alexandria Macmadu; Jennifer J Carroll; Scott E Hadland; Traci C Green; Brandon D L Marshall Journal: Addict Behav Date: 2017-01-06 Impact factor: 3.913
Authors: S A Strathdee; A Palepu; P G Cornelisse; B Yip; M V O'Shaughnessy; J S Montaner; M T Schechter; R S Hogg Journal: JAMA Date: 1998-08-12 Impact factor: 56.272
Authors: Julie K O'Donnell; John Halpin; Christine L Mattson; Bruce A Goldberger; R Matthew Gladden Journal: MMWR Morb Mortal Wkly Rep Date: 2017-11-03 Impact factor: 17.586
Authors: Evan Wood; Thomas Kerr; Brandon D L Marshall; Kathy Li; Ruth Zhang; Robert S Hogg; P Richard Harrigan; Julio S G Montaner Journal: BMJ Date: 2009-04-30