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. 2023 Nov 1:252:110985.
doi: 10.1016/j.drugalcdep.2023.110985. Epub 2023 Oct 5.

Prevalence of fentanyl in methamphetamine and cocaine samples collected by community-based drug checking services

Karla D Wagner  1 , Phillip Fiuty  2 , Kimberly Page  3 , Erin C Tracy  4 , Maryalice Nocera  5 , Colin W Miller  6 , Lina J Tarhuni  7 , Nabarun Dasgupta  8
Affiliations

Prevalence of fentanyl in methamphetamine and cocaine samples collected by community-based drug checking services

Karla D Wagner et al. Drug Alcohol Depend. .

Abstract

Background: Overdose deaths involving stimulants and opioids simultaneously have raised the specter of widespread contamination of the stimulant supply with fentanyl.

Methods: We quantified prevalence of fentanyl in street methamphetamine and cocaine, stratified by crystalline texture, analyzing samples sent voluntarily to a public mail-in drug checking service (May 2021-June 2023). Samples from 77 harm reduction programs and clinics originated in 25 US states. Sample donors reported expected drug and physical descriptions. Substances were identified by gas chromatography-mass spectrometry. Negative binomial models were used to calculate fentanyl prevalence, adjusting for potential confounders related to sample selection. We also examined if xylazine changed donors' accuracy of detecting fentanyl.

Results: We analyzed 718 lab-confirmed samples of methamphetamine (64%) and cocaine (36%). The adjusted prevalence of fentanyl was 12.5% (95% CI: 2.2%, 22.9%) in powder methamphetamine and 14.8% (2.3%, 27.2%) in powder cocaine, with notable geographic variation. Crystalline forms of both methamphetamine (Chisq=57, p<0.001) and cocaine (Chisq=18, p<0.001) were less likely to contain fentanyl: less than 1% of crystal methamphetamine (2/276) and no crack cocaine (0/53). Heroin was present in 6.6% of powder cocaine samples. Xylazine reduced donors' ability to detect fentanyl, with correct classification dropping from 92% to 42%.

Conclusions: Fentanyl was detected primarily in powder forms of methamphetamine and cocaine. Recommended interventions include expanding community-based drug checking, naloxone and fentanyl test strip distribution for people who use stimulants , and supervised drug consumption sites. New strategies to dampen variability in street drug composition are needed to reduce inadvertent fentanyl exposure.

Keywords: Cocaine; Drug checking; Epidemiology; Fentanyl; Harm reduction; Methamphetamine.

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Conflict of interest statement

Declaration of Competing Interest ND serves on the Scientific Advisory Board of the non-profit RADARS System of Denver Health and Hospitals Authority, which had no knowledge of or involvement in this manuscript. ND is also on the Board of Directors of the non-profit organization Remedy Alliance For The People. The remaining authors have no conflicts of interest to declare.

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