M Eugenia Socias1, Cameron Grant2, Kanna Hayashi3, Geoff Bardwell4, Mary Clare Kennedy4, M-J Milloy4, Thomas Kerr4. 1. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; University of British Columbia Department of Medicine, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada. Electronic address: bccsu-es@bccsu.ubc.ca. 2. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada. 3. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Simon Fraser University Faculty of Health Sciences, 8888 University Drive, Burnaby, BC V5A 1S6, Canada. 4. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; University of British Columbia Department of Medicine, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
Abstract
BACKGROUND: Although non-medical use of pharmaceutical opioids (POs) is associated with a number of risks, in the context of the opioid-overdose crisis, it may have the secondary benefit of decreasing the risk of exposure to more potent opioids from unregulated sources. The aim of this study was to assess the effects of using diverted POs on fentanyl exposure. METHODS: Using data from two prospective community-recruited cohorts of people who use drugs (PWUD) in Vancouver, Canada, we estimated the independent relationship between using diverted POs and fentanyl exposure (assessed through urine drug test [UDT]) between 2016 and 2018. We also explored if participant characteristics modified this relationship. RESULTS: Over the study period, among 1150 participants, 241 (21.0%) reported using diverted POs in 292 (12.8%) occasions. In adjusted analyses, PWUD using diverted POs had decreased odds of fentanyl exposure (Adjusted odds ratio [AOR] = 0.70, 95% CI: 0.52-0.94). The reduced odds of fentanyl exposure persisted among participants with morphine positive UDT (AOR = 0.57, 95% CI: 0.40-0.82), but not among those with negative morphine UDT (AOR = 0.91, 95% CI: 0.54-1.55). CONCLUSION: PWUD using diverted POs in our sample were 30% less likely to be exposed to fentanyl. This reduced likelihood was primarily observed among PWUD with morphine positive UDT, which could partially be explained by longer duration of action and lower street cost of slow-release oral morphine relative to other POs and fentanyl. Findings suggest that access to a regulated supply of pharmaceutical-grade opioids may serve to reduce fentanyl-related harms.
BACKGROUND: Although non-medical use of pharmaceutical opioids (POs) is associated with a number of risks, in the context of the opioid-overdose crisis, it may have the secondary benefit of decreasing the risk of exposure to more potent opioids from unregulated sources. The aim of this study was to assess the effects of using diverted POs on fentanyl exposure. METHODS: Using data from two prospective community-recruited cohorts of people who use drugs (PWUD) in Vancouver, Canada, we estimated the independent relationship between using diverted POs and fentanyl exposure (assessed through urine drug test [UDT]) between 2016 and 2018. We also explored if participant characteristics modified this relationship. RESULTS: Over the study period, among 1150 participants, 241 (21.0%) reported using diverted POs in 292 (12.8%) occasions. In adjusted analyses, PWUD using diverted POs had decreased odds of fentanyl exposure (Adjusted odds ratio [AOR] = 0.70, 95% CI: 0.52-0.94). The reduced odds of fentanyl exposure persisted among participants with morphine positive UDT (AOR = 0.57, 95% CI: 0.40-0.82), but not among those with negative morphine UDT (AOR = 0.91, 95% CI: 0.54-1.55). CONCLUSION: PWUD using diverted POs in our sample were 30% less likely to be exposed to fentanyl. This reduced likelihood was primarily observed among PWUD with morphine positive UDT, which could partially be explained by longer duration of action and lower street cost of slow-release oral morphine relative to other POs and fentanyl. Findings suggest that access to a regulated supply of pharmaceutical-grade opioids may serve to reduce fentanyl-related harms.
Authors: Jens Reimer; Nat Wright; Lorenzo Somaini; Carlos Roncero; Icro Maremmani; Neil McKeganey; Richard Littlewood; Peter Krajci; Hannu Alho; Oscar D'Agnone Journal: Eur Addict Res Date: 2015-10-02 Impact factor: 3.015
Authors: Benedikt Fischer; Thepikaa Varatharajan; Kevin Shield; Jürgen Rehm; Wayne Jones Journal: Drug Alcohol Depend Date: 2018-05-29 Impact factor: 4.492
Authors: Brittany B Dennis; Pavel S Roshanov; Monica Bawor; James Paul; Michael Varenbut; Jeff Daiter; Carolyn Plater; Guillame Pare; David C Marsh; Andrew Worster; Dipika Desai; Lehana Thabane; Zainab Samaan Journal: Pain Physician Date: 2016-01 Impact factor: 4.965