Prevalence and drug use correlates of inadvertent fentanyl exposure among individuals misusing drugs in seven U.S. states

Abstract

Background:

Fentanyl has emerged as the leading cause of fatal drug overdoses in the U.S. Individuals misusing drugs may not always be aware of exposure to fentanyl.

Objectives:

To determine the prevalence of fentanyl use and extent of awareness of fentanyl exposure among a national sample of treatment-seeking individuals with opioid use disorder (n = 1098).

Methods:

Participants provided oral fluid and urine specimens, which were tested for drugs by liquid chromatography/tandem mass spectrometry. Participants also provided self-reports of fentanyl use.

Results:

49.5% tested positive for fentanyl in oral fluid, urine, or both. Of those testing positive for fentanyl, 29.8% were unaware that they had been exposed to fentanyl. Participants testing positive for opioids methadone, and specifically 6-monoacetylmorphine (6-MAM), a unique metabolite of heroin, were significantly more likely to be unaware of fentanyl exposure than participants testing negative for these substances, with a similar trend for oxycodone and tramadol.

Conclusions:

These findings may be due to fentanyl’s effect being difficult to distinguish from that of other opioids, whereas when other types of drugs are adulterated with fentanyl, the differences in effects are likely to be readily discernable. These results support the importance of expanded drug-checking services.

Keywords:

• Fentanyl exposure
• unintentional drug use
• substance misuse
• fentanyl misuse
• opioid crisis
• fentanyl

Acknowledgements

We gratefully acknowledge the invaluable assistance of the following organizations that made this study possible: Cherry Health – Muskegon Recovery Center, Cherry Health – Southside Health Center, Chilton County Treatment Center, Community Medical Services Columbus on Dublin, JSAS HealthCare, Inc, Maric Healthcare LLC, New Directions Treatment Services, Inc., Rightway Medical of Oklahoma City South (Oklahoma Treatment Services LLC), Shelby County Treatment Center, Tadiso Incorporated, Thomasville Treatment Associates (Treatment Centers LLC), Tulsa Rightway Medical (Oklahoma Treatment Services LLC), Stop Stigma Now (SSN), American Association for the Treatment of Opioid Dependence, Inc.(AATOD). Mary E. Ramlow provided important administrative support.

Disclosure statement

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

Additional information

Funding

This work was supported by grant # 5R01DA045733 from the National Institute on Drug Abuse (NIDA)