By Bruce Wallace, Irene Shkolnikov, Collin Kielty, Derek Robinson, et al.

Background Illicit opioids, including fentanyl, are linked to unprecedented levels of overdose in Canada and elsewhere. The risks associated with illicit opioids can include high potency, unpredictable concentration and the unexpected presence in other drugs. Within this context, we examine drug checking data to better understand the presence of illicit opioids such as fentanyl in other drugs and possible ways to interpret these results. Methods Three years (2021–2023) of data (18,474 samples) from Substance Drug Checking in British Columbia, Canada were examined to investigate the risks associated with the detection of opioids in other drugs such as cocaine and methamphetamine, as well as in other drug categories. Samples were tested by paper spray mass spectrometry (PS-MS), fentanyl test strips and Fourier-Transform infrared spectroscopy (FTIR). We examine the 8889 samples not expected to include fentanyl to confirm; if the expected drug was detected, if unexpected opioids were detected, and when the unexpected opioids are in trace concentration. Results Unexpected opioids were rarely detected (2%) in other drugs (189 of 8889 samples) with most (61.4%) detected at trace concentration levels. Unexpected opioids are far more likely to be found in samples that did not contain the expected drug than in samples that were confirmed to contain the expected drug. The least common scenario (below 1%) were substances that included the expected drug plus unexpected opioid above trace concentration. These findings raise questions on how to interpret and communicate the detection of fentanyl and related opioids in other drugs. We present three potential interpretations: (1) mistaken and misrepresented samples where the expected drug was never detected, (2) cross contamination when opioids were at trace concentration levels, or (3) adulteration as the least frequent scenario where opioids were detected above trace concentrations in combination with the expected drug. Conclusions In a region where fentanyl is associated with extreme rates of overdose, it remains rare to find such opioids in other drugs. However, the risk of fentanyl in other drugs remains an ongoing threat that warrants responses by individuals and public health. We provide possible interpretations to inform such responses. Our data raises questions on how to interpret and communicate the detection of fentanyl and other opioids in other drugs.

Harm Reduction Journal, (2025) 22:28, 8p.

By Tse Yang Lim, Huiru Dong, Erin Stringfellow, Zeynep Hasgul, Ju Park, Lukas Glos, Reza Kazemi, and Mohammad S Jalali

Fentanyl and its analogs contribute substantially to drug overdose deaths in the United States. There is concern that people using drugs are being unknowingly exposed to fentanyl, increasing their risk of overdose death. This study examines temporal trends and spatial variations in the co-occurrence of fentanyl with other seized drugs.

Methods

We identified fentanyl co-occurrence (the proportion of samples of non-fentanyl substances that also contain fentanyl) among 9 substances or substance classes of interest: methamphetamine, cannabis, cocaine, heroin, club drugs, hallucinogens, and prescription opioids, stimulants, and benzodiazepines. We used serial cross-sectional data on drug reports across 50 states and the District of Columbia from the National Forensic Laboratory Information System, the largest available database on the U.S. illicit drug supply, from January 2013 to December 2023.

Findings

We analyzed data from 11,940,207 samples. Fentanyl co-occurrence with all examined substances increased monotonically over time (Mann-Kendall p < 0.0001). Nationally, fentanyl co-occurrence was highest among heroin samples (approx. 50%), but relatively low among methamphetamine (≤1%), cocaine (≤4%), and other drug samples. However, co-occurrence rates have grown to over 10% for cocaine and methamphetamine in several Northeast states in 2017–2023.

Interpretation:

Fentanyl co-occurs most commonly with heroin, but its presence in stimulant supplies is increasing in some areas, where it may pose a disproportionately high risk of overdose.

Lancet Reg Health Amicas, . 2024 Sep 27;39:100898. doi: 10.1016/j.lana.2024.100898

By The Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS),

Substance use and mental health issues have significant impacts on individuals, families, communities, and societies. The National Survey on Drug Use and Health (NSDUH), conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides nationally representative data on the use of tobacco, alcohol, and other substances including illicit drugs; substance use disorders; receipt of substance use treatment; mental health issues; and receipt of mental health treatment among the civilian, noninstitutionalized population aged 12 or older in the United States. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. SAMHSA is steadfast in its efforts to advance the health of the nation while also promoting equity. Therefore, this report, based on 2023 NSDUH data, contains findings on key substance use and mental health indicators in the United States by race or ethnicity. The 2021 to 2023 NSDUHs used multimode data collection, in which respondents completed the survey in person or via the web. Methodological investigations led to the conclusion that estimates based on multimode data collection in 2021 and subsequent years are not comparable with estimates from 2020 or prior years. Although estimates from 2021 to 2023 can be compared,6 this report presents NSDUH estimates from 2023 only. Results from the 2023 National Survey on Drug Use and Health: Detailed Tables show comprehensive estimates related to substance use and mental health for 2022 and 2023. The 2023 Companion Infographic Report: Results from the 2021, 2022, and 2023 National Surveys on Drug Use and Health shows comparisons of selected estimates from 2021 to 2023. Behavioral Health by Race and Ethnicity: Results from the 2021-2023 National Surveys on Drug Use and Health shows comparisons of selected estimates for racial or ethnic groups using pooled data from the 2021 to 2023 NSDUHs to increase the precision of estimates. Survey Background NSDUH is an annual survey sponsored by SAMHSA within the U.S. Department of Health and Human Services (HHS). NSDUH covers residents of households and people in noninstitutional group settings (e.g., shelters, boarding houses, college dormitories, migratory workers’ camps, halfway houses). The survey excludes people with no fixed address (e.g., people who are homeless and not in shelters), military personnel on active duty, and residents of institutional group settings, such as jails, nursing homes, mental health institutions, and long-term care hospitals.

Washington, DC: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.