Prevalence and longitudinal correlates of recent exposure to fentanyl among HIV-positive people who use unregulated drugs during a community-wide overdose crisis

ABSTRACT

The United States and Canada are experiencing an opioid overdose crisis driven largely by exposure to fentanyl (a potent synthetic opioid), with little known about fentanyl exposure among HIV-positive people who use unregulated drugs (PWUD). We sought to estimate the prevalence and correlates of fentanyl exposure among a community-recruited sample derived from a prospective cohort study of HIV-positive PWUD in Vancouver, Canada. Generalized linear mixed-effects analyses were used to identify longitudinal factors associated with a fentanyl-positive urine drug screen test. Between June 2016-November 2017, 456 participants were recruited and contributed 1007 observations. At baseline, 96% of participants were ART-exposed, 72% had an HIV viral load (VL) <50 copies/mL and 21% had a fentanyl-positive test. Longitudinally, fentanyl-positive tests were characterized by: younger participant age (Adjusted Odds Ratio [AOR] = 0.45), recent non-fatal overdose (AOR = 2.30), engagement in opioid agonist therapy (AOR = 1.91), and at least daily heroin injection (AOR = 11.27). CD4+ cell count was negatively associated with fentanyl urine positivity (AOR = 0.92) (all p < 0.05). We identified several risk factors for overdose linked to fentanyl exposure among this sample, although no link with HIV treatment engagement or detectable HIV VL. Innovative strategies are needed to reduce the harmful effects of the contaminated unregulated drug supply experienced by PWUD.

KEYWORDS:

• Fentanyl exposure
• overdose
• urine drug screen
• HIV-positive

Acknowledgments

The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff. SM completed the literature review and the first draft of the manuscript, with guidance and assistance from MJM. EK conducted the statistical analyses. EK, SN, NF, JL and KH made substantial contributions to the revision and editing of the manuscript. All authors made significant contributions and approved of the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study was supported by the United States National Institutes of Health (NIH) (U01DA021525). 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 Medicineas well as the Canadian Institutes of Health Research (CIHR) through the Canadian Research Initiative on Substance Misuse (SMN–139148). SM is supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship-Master’s (CGS-M) award. MJM is supported by a CIHR New Investigator Award, a Michael Smith Foundation for Health Research (MSFHR) Scholar Award and the US NIH (U01-DA0251525). 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 established through arms’ length gifts to the university from Canopy Growth Corporation, a licensed producer of cannabis in Canada, and the Government of British Columbia’s Ministry of Mental Health and Addictions. He has no personal financial relationships to the cannabis industry. SN is supported by a MSFHR Health Professional Investigator Award and the University of British Columbia’s Steven Diamond Professorship in Addiction Care Innovation. NF is supported by a St . Paul’s Foundation/Michael Smith Foundation for Health Research Scholar Award. KH holds the St. Paul’s Hospital Chair in Substance Use Research and is supported by a CIHR New Investigator Award (MSH-141971), a MSFHR Scholar Award, and the St. Paul’s Foundation.