Changes in drug use behaviors coinciding with the emergence of illicit fentanyl among people who use drugs in Vancouver, Canada

ABSTRACT

Background: With the emergence of illicitly-manufactured fentanyl, drug overdose deaths have risen in unprecedented numbers. In this context, there is an urgent need to characterize potential changes in drug use behaviors among people who use drugs (PWUD).

Objective: To examine changes in drug use behaviors following the emergence of illicit fentanyl among people who use drugs (PWUD).

Methods: Data for this cross-sectional analysis was derived from three prospective cohorts of PWUD between December 2016 and May 2017 in Vancouver, Canada. Multivariable logistic regression was used to determine factors associated with self-reported behavior changes (binary variable “yes” or “no”) following the emergence of illicit fentanyl.

Results: Among 999 participants [363 (36.3%) females], 388 (38.8%) reported some behavior change. The remaining 611 (61.2%) reported no change in behavior; 240 (39.3%) of these individuals had recently been exposed to fentanyl. In multivariable analyses, factors independently associated with behavior change included recent non-fatal overdose (Adjusted Odds Ratio [AOR] = 2.28), active injection drug use (AOR = 1.96), being on opioid agonist therapy (AOR = 1.80), and urine drug screen positive for fentanyl (AOR = 1.45), (all p < .05).

Conclusion: The majority of PWUD in our sample did not change their drug use behavior despite a high prevalence of fentanyl exposure, indicating a need for targeted behavior change messaging and overdose prevention efforts such as naloxone and addiction treatment for this sub-population of PWUD. Further, the high fentanyl exposure observed in our sample suggests a need to address upstream structural factors shaping the overdose risk in addition to individual behavioral change.

KEYWORDS:

• Fentanyl
• overdose
• injection drug use
• addiction treatment
• drug use pattern
• opioid agonist therapy

Acknowledgements

The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff.

Disclosures/funding

The authors have no conflicts of interest to declare. The study was supported by the US National Institutes of Health (NIH) (U01DA038886, U01DA021525, R25DA037756). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine which supports EW, and the Canadian Institutes of Health Research (CIHR) Canadian Research Initiative on Substance Misuse (SMN–139148). KH is supported by a CIHR New Investigator Award (MSH-141971), a Michael Smith Foundation for Health Research (MSFHR) Scholar Award, and the St. Paul’s Foundation. MJM is supported by a CIHR New Investigator Award, a MSFHR Scholar Award and the US NIH (U01DA021525). His institution has received an unstructured gift from NG Biomed, Ltd., to support his research. He is the Canopy Growth professor of cannabis science at the University of British Columbia, a position created by unstructured gifts to the university from Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia’s Ministry of Mental Health and Addictions. KD is supported by a MSFHR/St. Paul’s Hospital Foundation– Providence Health Care Career Scholar Award and a CIHR New Investigator Award. NF is supported by MSFHR/St. Paul’s Hospital Foundation Scholar Award.