Substance use patterns associated with recent exposure to fentanyl among people who inject drugs in Vancouver, Canada: A cross-sectional urine toxicology screening study.
Substance use patterns associated with recent exposure to fentanyl among people who inject drugs in Vancouver, Canada: A cross-sectional urine toxicology screening study.
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DOI：
10.1016/j.drugalcdep.2017.10.020
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发表时间：
2018-02-01
影响因子：
4.2
通讯作者：
Kerr T
中科院分区：
文献类型：
--
作者：
Hayashi K;Milloy MJ;Lysyshyn M;DeBeck K;Nosova E;Wood E;Kerr T
加拿大温哥华正在经历阿片类药物过量危机，在大多数致命的过量病例中发现了芬太尼，这是一种污染非法药物供应的强效合成阿片类药物。尽管芬太尼在整个北美的存在越来越多，但很少有研究表明使用非法药物的人（PWUD）暴露于芬太尼。我们试图确定温哥华的PWUD中芬太尼暴露的患病率和相关性。数据来自温哥华的PWUD队列研究。在2016年6月至10月，我们进行了多面板尿液药物筛查（UDS），以检测最近暴露于芬太尼和其他八种物质。多变量逻辑回归用于识别与过去六个月注射药物的参与者（PWID）最近芬太尼暴露相关的物质使用模式。在669名PWUD中，包括250名（37.4%）女性和452名（67.6%）PWID，97名（14.5%）芬太尼检测阳性。所有这些人还对其他物质检测呈阳性，最常见的是吗啡/海洛因（89.9%），苯丙胺/甲基苯丙胺（75.3%）和可卡因（74.2%）。PWID中芬太尼检测率（19.7%）显著高于非注射吸毒者（3.9%）（p<0.001）。在多变量分析中，年龄较小（调整后的比值比[AOR]：0.96）和吗啡/海洛因（AOR：6.73），丁丙诺啡（AOR：4.25），苯丙胺/甲基苯丙胺（AOR：3.26），可卡因（AOR：2.92）和大麻（AOR：0.52）检测阳性仍然与芬太尼暴露独立相关（所有p<0.05）。由于五分之一的PWID暴露于芬太尼，迫切需要设计和扩大干预措施以降低过量风险，包括一系列阿片类激动剂治疗。
Vancouver, Canada is experiencing an opioid overdose crisis where fentanyl, a potent, synthetic opioid contaminating the illicit drug supply, has been detected in the majority of fatal overdose cases. Despite its growing presence throughout North America, few studies have characterized exposure to fentanyl among people who use illicit drugs (PWUD). We sought to identify the prevalence and correlates of fentanyl exposure among PWUD in Vancouver. Data were derived from cohort studies of PWUD in Vancouver. In June –October 2016, we administered multi-panel urine drug screens (UDS) to detect recent exposure to fentanyl and eight other substances. Multivariable logistic regression was used to identify substance use patterns associated with recent fentanyl exposure among participants who injected drugs in the past six months (PWID). Among 669 PWUD including 250 (37.4%) females and 452 (67.6%) PWID, 97(14.5%) tested positive for fentanyl. All these individuals also tested positive for other substances, most commonly for morphine/heroin (89.9%), amphetamine/methamphetamine(75.3%) and cocaine (74.2%). A fentanyl detection rate was significantly higher among PWID (19.7%) compared to non-injection drug users (3.9%) (p<0.001). In multivariable analyses, younger age (adjusted odds ratio [AOR]: 0.96) and testing positive for morphine/heroin (AOR: 6.73), buprenorphine (AOR: 4.25), amphetamine/methamphetamine (AOR: 3.26), cocaine (AOR: 2.92) and cannabis (AOR: 0.52) remained independently associated with fentanyl exposure (all p<0.05). With one in five PWID being exposed to fentanyl, there is an urgent need to design and scale up interventions to reduce overdose risk, including a range of opioid agonist therapies.
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DOI：
10.1136/bmj.b1649
发表时间：
2009-04-30
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Wood E;Kerr T;Marshall BD;Li K;Zhang R;Hogg RS;Harrigan PR;Montaner JS
通讯作者：
Montaner JS
影响因子：
4.4
作者：
Amlani A;McKee G;Khamis N;Raghukumar G;Tsang E;Buxton JA
通讯作者：
Buxton JA
影响因子：
33.9
作者：
Rudd, Rose A.;Seth, Puja;Scholl, Lawrence
通讯作者：
Scholl, Lawrence
影响因子：
4.4
作者：
Socias, M. Eugenia;Kerr, Thomas;Milloy, M-J
通讯作者：
Milloy, M-J
影响因子：
33.9
作者：
Klar, Salman A.;Brodkin, Elizabeth;Lee, Victoria
通讯作者：
Lee, Victoria