Opioid Pandemic: more people knowingly use fentanyl

New research out of the University of British Columbia reveals that the use of the synthetic opioid, fentanyl, has doubled since 2015

Fentanyl is a synthetic opioid 50 to 100 times more toxic than morphine. According to preliminary data from the British Columbia Coroner’s Service, fentanyl or its counterparts such as carfentanil were found in 85% of fatal overdose cases in 2019.

The findings from the University of British Columbia and the BC Centre for Disease Control (BCCDC) finds that over two-thirds of drug users have knowingly taken the drug. The Canadian province has experienced the highest number of illicit drug toxicity deaths as a result of the opioid crisis.

These findings highlight the importance of taking comprehensive measures to reduce the risk for people who take toxic opioids knowingly or unknowingly. The study is based on 2018 survey data collected from people who visit harm reduction sites for supplies like new syringes and needles or safer smoking supplies.

The research, published this week in the International Journal of Drug Policy, provides valuable insights into fentanyl use that will help to inform efforts to reduce overdoses and deaths in B.C. and beyond.

Dr Jane Buxton, BCCDC epidemiologist, harm reduction lead and professor in the UBC School of Population and Public Health said: “This research shows the majority of people who use fentanyl know they’re doing so. Making people who use drugs aware of the presence of fentanyl in the drug supply isn’t enough; we need harm reduction services, substance use treatment, overdose prevention resources, and pharmaceutical alternatives to the toxic drug supply to reduce the devastating impact of fentanyl and its analogues on our communities.”

Many people took fentanyl unknowingly when sourcing drugs like heroin, counterfeit opioid tablets or other substances. When it first appeared in the drug supply, British Columbia saw a huge spike in deaths from the contaminated drug supply and instituted measures to prevent deaths including distribution of kits containing the overdose-reversing drug naloxone, increased access to treatments for opioid use disorder substitution treatment, and expansion of overdose prevention services and supervised consumption sites.

At the time, B.C. Scientists and health care workers wanted to know whether people were still unaware they were taking fentanyl, so they repeated a study done in 2015, shortly after fentanyl entered the drug supply.

The scientists analysed data collected from 303 participants recruited from 27 harm reduction sites across British Columbia. The participants completed a brief survey on their drug use and provided a urine sample that researchers tested for fentanyl and other substances.

In 2018, 60% of participants had fentanyl detected in their urine, of these people, 64% knew they had taken fentanyl. The study done in 2015 found 29% of participants tested positive for fentanyl, with only 27% aware that they’d used it.

Researchers do not fully understand the factors that contribute to people knowingly taking fentanyl, but the reasons are varied. Some people may use fentanyl because they are aware it is present in most of the illicit supply of opioids and therefore have no other choice, while some may prefer the experience of taking fentanyl regardless of other options.

Mohammad Karamouzian, PhD student at UBC’s School of Population and Public Health and a lead author of the study said: “This research lays the groundwork that will help us learn more about why fentanyl use is increasing. These findings will also contribute to more effective messaging campaigns and harm reduction strategies to help reduce preventable deaths and support the health of people who use substances, their families, and their communities.”

Other findings from the study:

• More recently, fentanyl use was more common in people living in urban settings.
• Heroin/morphine or crystal meth users were also likely to have used fentanyl recently.
• Cannabis use was associated with reduced fentanyl use.
• The data used for this study were collected at harm reduction sites that provide a range of services to people who use drugs including, but not limited to condom distribution, needle and syringe distribution and take-home naloxone kits.
• A study led by BCCDC in 2019 showed the rapid expansion of harm reduction services (for example take-home naloxone, opioid agonist therapy and overdose prevention sites) in response to British Columbia’s overdose crisis averted more than 3,000 overdose deaths during a 20-month period in 2016-2017.