Street fentanyl use: Experiences, preferences, and concordance between self-reports and urine toxicology

Raminta Daniulaityte, Robert R. Carlson, Matthew P. Juhascik, Kraig E. Strayer, Ioana E. Sizemore

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Background: Conducted in Dayton, Ohio, the study aims to characterize user knowledge and experiences with non-pharmaceutical fentanyl-type drugs (NPFs) and compare self-reports with urine toxicology for NPFs and heroin. Methods: Between May 2017–January 2018, 60 individuals who self-reported heroin/NPF use were interviewed using structured questionnaire on socio-demographics, NPF and other drug use practices. Unobserved urine samples were collected and analyzed using: 1) liquid-chromatography-tandem mass spectrometry (LC–MS/MS)-based method (Toxicology lab) to identify 34 fentanyl analogues, metabolites, and other synthetic opioids; 2) immunoassay-based method to screen for opiates (heroin). Sensitivity, specificity and Cohen's kappa were calculated to assess agreement between self-reports and urine toxicology. Results: The sample was 52% female, and over 90% white. Almost 60% reported preference for heroin, and 40% for NPF. Participants endorsed a number of ways of distinguishing heroin from NPF, including appearance (88.3%), effects (76.7%), taste (55%), and information provided by dealers (53.3%). Almost 80% felt confident they could distinguish heroin from NPF, but knowledge about fentanyl analogues was limited. LC–MS/MS testing identified 8 types of NPFs. Over 88% tested positive for NPFs, including 86% fentanyl, 48% carfentanil, 42% acetyl fentanyl. About 47% screened positive for opiates/heroin, and all of them were also positive for NPFs. When comparing self-reported use of NPF to urine toxicology, sensitivity and specificity were relatively high (84% and 83.3%, accordingly), while Cohen's Kappa was 0.445, indicating fair agreement. Sensitivity and specificity were lower for heroin (77.8% and 50.0%, accordingly), and Cohen's Kappa was 0.296, indicating low agreement between self-reports of heroin use and urine toxicology. Discussion: Nearly 90% of the study participants tested positive for NPF-type drugs. Participants were more likely to over-report heroin use and underreport NPF use. The majority had little knowledge about fentanyl analogues. Study findings will inform development of novel harm reduction approaches to reduce overdose mortality.

Original languageEnglish (US)
Pages (from-to)3-9
Number of pages7
JournalInternational Journal of Drug Policy
Volume71
DOIs
StatePublished - Sep 2019
Externally publishedYes

Keywords

  • Carfentanil
  • Fentanyl
  • Fentanyl analogues
  • Heroin
  • Non-pharmaceutical fentanyl
  • Novel synthetic opioids
  • Urine toxicology

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

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