Urine drug screening for early detection of unwitting use of fentanyl and its analogues among people who inject heroin in Sydney, Australia
Urine drug screening for early detection of unwitting use of fentanyl and its analogues among people who inject heroin in Sydney, Australia
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DOI：
10.1111/dar.12864
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发表时间：
2018-11-01
影响因子：
3.8
通讯作者：
Nielsen, Suzanne
中科院分区：
文献类型：
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作者：
Barratt, Monica J.;Latimer, Julie;Nielsen, Suzanne
由于无意中消费非药物芬太尼及其类似物，北美的致命阿片类药物过量急剧增加。虽然这场危机的一些驱动因素-包括盈利能力和通过互联网来源获得高效阿片类药物-也适用于澳大利亚，但据我们所知，没有对当地人群进行持续的监测研究。因此，本试验性研究旨在通过即时尿液筛查检测注射海洛因的人中的无意芬太尼消费，并确定在悉尼国王十字医疗监督注射中心对客户进行自愿尿液分析的可行性和可接受性。设计和方法结果对第1波（2017年10月）的67名参与者和第2波（2018年3月）的51名参与者进行了简要调查和尿液药物筛查。用BTNX Rapid Response（TM）芬太尼尿条测试在20 ng/mL去甲芬太尼的检测水平下测试尿样。这些试纸也与许多芬太尼类似物发生交叉反应。在本研究中，没有发现尿液检测阳性表明无意中使用芬太尼的病例。讨论和结论这些负面发现与加拿大的类似研究形成鲜明对比。虽然到目前为止还没有发现芬太尼掺杂海洛因使用的案例，但我们已经证明，这种监测设计是一种低成本、可行且可扩展的方法，可以监测澳大利亚未被发现的芬太尼及其类似物对公共卫生的巨大威胁。进一步验证试纸的交叉反应性将加强该方法。
Introduction and Aims North America has witnessed a dramatic rise in fatal opioid overdoses due to the unwitting consumption of non-pharmaceutical fentanyl and its analogues. While some of the drivers of this crisis-including profitability and access to high-potency opioids through internet sources-also apply in Australia, to our knowledge, there have been no ongoing surveillance studies of local populations. Therefore, this pilot study aimed to detect unintentional fentanyl consumption among people who inject heroin through instant urine screening, and determine the feasibility and acceptability of voluntary urinalysis of clients at the Medically Supervised Injecting Centre, Kings Cross, Sydney. Design and Methods Results Brief surveys and urine drug screens were conducted with 67 participants in Wave 1 (October 2017) and 51 participants in Wave 2 (March 2018). Urine samples were tested with BTNX Rapid Response (TM) fentanyl urine strip test at a detection level of 20 ng/mL norfentanyl. These strips also cross-react to numerous fentanyl analogues. There were no cases where positive urine tests suggested unwitting fentanyl use detected in this study. Discussion and Conclusions These negative findings contrast sharply with similar Canadian studies. While no cases of fentanyl-laced heroin use have been detected so far, we have demonstrated that this surveillance design is low-cost, feasible and scalable approach to monitoring the considerable public-health threat of undetected fentanyl and its analogues in Australia. Further validation of cross-reactivity of test strips would strengthen this method.