title: Why the FUSS (Fentanyl Urine Screen Study)? A cross-sectional survey to characterize an emerging threat to people who use drugs in British Columbia, Canada.
abstract: BACKGROUND
  Fentanyl-detected illicit drug overdose deaths in British Columbia (BC) recently increased dramatically from 13 deaths in 2012 to 90 deaths in 2014, signaling an emerging public health concern. Illicit fentanyl is sold as pills or powders, often mixed with other substances like heroin or oxycodone; reports from coroners suggested that fentanyl was frequently taken unknowingly by people who use drugs. This study aimed to assess the prevalence and characteristics of fentanyl use among clients accessing harm reduction (HR) services in BC.
  
  
  METHODS
  Participants attending HR services at 17 sites across BC were invited to complete an anonymous questionnaire describing drugs they have used within the last 3 days and provide a urine sample to test for fentanyl. Data from eligible participants were analyzed using descriptive, bivariate, and multivariate statistical methods.
  
  
  RESULTS
  Surveys from 17 HR sites were received, resulting in analysis of responses from 242 eligible participants. Most participants used multiple substances (median = 3), with crystal meth (59%) and heroin (52%) use most frequently reported. Seventy participants (29%) tested positive for fentanyl, 73% of whom did not report using fentanyl. Controlling for age, gender, and health authority, reported use of fentanyl (odds ratio (OR) = 6.13, 95% confidence interval (CI) = [2.52, 15.78], p < 0.001) and crystal methamphetamine (OR = 3.82, 95% CI = [1.79, 8.63], p < 0.001) use were significantly associated with fentanyl detection.
  
  
  CONCLUSIONS
  The proportion of those testing positive who did not report knowingly using fentanyl represents a considerable public health concern. The risk of overdose among this vulnerable population highlights the need for targeted HR strategies, such as increased accessibility to naloxone, overdose education, and urine screens.
authors.affiliation: British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada. ashraf.amlani@bccdc.ca.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Amlani
authors.affiliation: School of Public and Population Health, University of British Columbia, Vancouver, Canada. gwmckee@gmail.com.
authors.forename: Geoff
authors.initials: G
authors.lastname: McKee
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, Canada. noren.khamis@gmail.com.
authors.forename: Noren
authors.initials: N
authors.lastname: Khamis
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, Canada. geetharaghukumar@gmail.com.
authors.forename: Geetha
authors.initials: G
authors.lastname: Raghukumar
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, Canada. ertsang@alumni.ubc.ca.
authors.forename: Erica
authors.initials: E
authors.lastname: Tsang
authors.affiliation: British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada. jane.buxton@bccdc.ca.|Faculty of Medicine, University of British Columbia, Vancouver, Canada. jane.buxton@bccdc.ca.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Buxton
mesh_terms: D000328:Adult; D001955:British Columbia; D003430:Cross-Sectional Studies; D005260:Female; D005283:Fentanyl / Q000652:urine*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000652:urine*; D015995:Prevalence; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000652:urine*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D009294:Narcotics; D005283:Fentanyl