Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 1:228:109006.
doi: 10.1016/j.drugalcdep.2021.109006. Epub 2021 Aug 28.

Buprenorphine/naloxone associated with a reduced odds of fentanyl exposure among a cohort of people who use drugs in Vancouver, Canada

Samantha Young  1 , Kanna Hayashi  2 , Cameron Grant  3 , M J Milloy  4 , Kora DeBeck  5 , Evan Wood  4 , Nadia Fairbairn  6
Affiliations

Buprenorphine/naloxone associated with a reduced odds of fentanyl exposure among a cohort of people who use drugs in Vancouver, Canada

Samantha Young et al. Drug Alcohol Depend. .

Abstract

Background: Little is known about the relationship between opioid agonist therapy (OAT) and fentanyl use, specifically. This study aimed to estimate the association between current use of different forms of OAT, including methadone, buprenorphine/naloxone (BUP/NX), slow release oral morphine (SROM), or injectable opioid agonist treatment (iOAT), and the likelihood of a fentanyl-positive urine drug test (UDT) as compared to no OAT.

Methods: Data were obtained from three community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada from December 2016 through November 2018. Using multivariable Generalized Estimating Equations (GEE), we examined the association between current use of each form of OAT, as compared to no OAT, and fentanyl-positive UDT among participants who use opioids.

Results: The 915 participants contributed 2112 UDTs over a median of two follow-up visits. The majority of UDTs (74.9 %) were positive for fentanyl. After adjustment for a priori defined confounding factors, compared to no OAT, current use of BUP/NX was associated with lower odds of fentanyl-positive UDT (odds ratio [OR] = 0.36, 95 % confidence interval [CI]: 0.22-0.58) while current use of methadone (OR = 0.84, 95 % CI: 0.65-1.07), iOAT (OR = 1.30, 95 % CI: 0.75-2.28), and SROM (OR = 1.34, 95 % CI: 0.74-2.43) were not.

Conclusions: In this cohort of people who use opioids in Vancouver, only use of BUP/NX was associated with lower odds of fentanyl-positive UDT. Our findings highlight high rates of ongoing fentanyl use despite the use of OAT and support the expansion of BUP/NX for the treatment of people who use fentanyl.

Keywords: Fentanyl; Opiate substitution treatment; Opioid addiction; Urine drug test.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest

No conflict declared.

Figures

Fig. 1.
Fig. 1.
Directed acyclic graph (DAG) representing the proposed causal relationship between opioid agonist therapy and fentanyl exposure. *Unmeasured outcome of interest; urine drug test is used as a surrogate measure.
See this image and copyright information in PMC

References

    1. American Society of Addiction Medicine, 2020. The ASAM National Practice Guideline For the Treatment of Opioid Use Disorder: 2020 Focused Update. - PubMed
    1. Arfken CL, Suchanek J, Greenwald MK, 2017. Characterizing fentanyl use in methadone-maintained clients. J. Subst. Abuse Treat 75, 17–21. - PubMed
    1. Brico E, 2020. Starting Bupe From Fentanyl Can Be a Nightmare. Microdosing Methods Help. Filter
    1. British Columbia Centre on Substance Use, 2017. A Guideline for the Clinical Management of Opioid Use Disorder. https://www.bccsu.ca/wp-content/uploads/2017/06/BC-OUD-Guidelines_June20... (Accessed 9 April 2020).
    1. Canadian Research Initiative in Substance Misuse, 2019. National Injectable Opioid Agonist Treatment for Opioid Use Disorder Clinical Guideline. https://crism.ca/projects/ioat-guideline/ (Accessed 9 April 2020).

Publication types

MeSH terms