Prevalence of recent fentanyl use among treated users of illicit opioids in England: based on piloted urine drug screens

Abstract

Objective: To use a pilot of national fentanyl screening to establish the current prevalence of recent fentanyl use among treated users of illicit opioids in the English treatment system and inform the design of a full study.

Design: Cross-sectional fentanyl metabolite urine screening in randomly-selected study sites, stratified to cover all nine geographical regions of England, supplemented with self-report subsequent to a positive fentanyl test.

Patients: 468 adult (18 years of age and above) patients receiving treatment for opioid use disorder, screened December 2017 to May 2018.

Results: The fentanyl-positive rate in patients receiving treatment for opioid use disorder in the English treatment system was 3% (15/468, 95% CI 1.8% to 5.2%) with a per-site range (for the 10 sites in 9 regions where fentanyl was detected) of between 2% (1/57) and 15% (4/27). Self-report data indicated that the majority of fentanyl-positives (12/15, 80%) was unaware of having purchased fentanyl.

Conclusions: Despite alerts already in place, patients receiving treatment for opioid use disorder, who were fentanyl-positive, were unwittingly purchasing and consuming fentanyl.

Keywords:

• Fentanyl
• opioid
• substance use disorder
• substance use treatment
• prevalence

Acknowledgements

The authors would like to thank those individuals who made the study possible, specifically Donal Cairns, Stefan Jahr, Andrew Jones and Elin Williams at The University of Manchester; Harry Wallace of CGL; CGL treatment service personnel in study sites and CGL patients, in particular.

Disclosure statement

PB: Fellow of the Royal College of Psychiatrists, Executive on Addiction Faculty. Technical Committee Member, Advisory Council on the Misuse of Drugs.

KPH: has received research grant funding from Change, Grow, Live (CGL), a third-sector provider of substance misuse services.

SMB: Served on Scotland’s National Naloxone Advisory Group.

TM: has received research funding from Change, Grow Live, the UK National Treatment Agency for Substance Misuse/Public Health England, and the Home Office; has been a member of the organising committee for conferences supported by unrestricted educational grants from Reckitt Benckiser, Lundbeck, Martindale Pharma, and Britannia Pharmaceuticals Ltd, for which he received no personal remuneration; is a member of the Advisory Council on the Misuse of Drugs.

Additional information

Funding

This study was funded by Change, Grow, Live (CGL), one of the main UK providers of substance use disorder treatment services.