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Posts tagged substance use
Is fentanyl in everything? Examining the unexpected occurrence of illicit opioids in British Columbia’s drug supply

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.

Temporal and spatial trends of fentanyl co-occurrence in the illicit drug supply in the United States: a serial cross-sectional analysis

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