Monitoring for Fentanyl and Novel Psychoactive Substances Within Supervised Injecting Facilities: Testing Three Different Approaches in Australia

Author: Suzanne Nielsen Monica Barratt Sarah Hiley Nico Clark Mark Bartlett Julie Latimer Marianne Jauncey Claude Roux Marie Morelato Michael Gilbert Michala Kowalski Dimitri Gerostamoulos Marie Linda Glowacki Leanne Francia Tina Lam

Theme: Epidemiology & Public Health Research Year: 2022

Introduction: Australia is yet to see consistent signals of fentanyl-contaminated heroin, despite
widespread emergence in other countries. This study tested novel methods to monitor for fentanyl
and other novel psychoactive substances (NPS).
Methods: Clients from two medically supervised injecting facilities (SIFs) contributed urine screens
with BTNX Rapid Response™ fentanyl test strips (FTS) paired with surveys, and injecting equipment
associated with opioid overdoses for laboratory analysis. A single site piloted drug checking with FTS
with laboratory confirmation. Two online workshops were conducted with key experts (n = 21,
including SIF staff, content experts and people with lived experience) to understand how results may
inform future testing for NPS within the supervised injecting facilities.
Results: Of the 911 FTS conducted on urine, 17 yielded positive results, of which 8 were not
explained by self-reported fentanyl use. Confirmatory laboratory analysis was conducted on six, with
four deemed to be false positives, and two confirmed fentanyl presence. Injecting equipment tested
from 59 overdoses did not find fentanyl and other NPS. Drug checking with FTS (n=40) showed four
positive results. Two were laboratory tested and classified as false positives. Workshop participants
felt routine monitoring for FTS may have limited value currently, until there is a significant change in
overdose rates, or other signals to warrant testing. A process for using pre-defined signals to trigger
surveillance was defined.
Conclusion: This study demonstrates the feasibility of quick onsite testing for fentanyl. However,
the high false positive rate emphasizes the need for confirmation of positive FTS through advanced
analytical techniques, and the need to better understand drivers of false positives, such as test
interpretation and adulterants. While the role of routine FTS use is unclear within the current lowfentanyl context, a rapid response process was established should signals of increased fentanyl prevalence in the Australian heroin market emerge.
Disclosure of Interest Statement:
This research is funded by the Commonwealth of Australia via research grant from the National
Centre for Clinical Research on Emerging Drugs. SN is the recipients of a National Health and Medical
Research Council (NHMRC) Research Fellowship (#1163961). SN and TL have received unrelated untied educational grants from Seqirus to investigate prescription opioid related harms. SN is a named investigator on a research grant from Indivior on a long-acting injectable buprenorphine implementation study.

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