Increasing preference for fentanyl among a cohort of people who use opioids in Vancouver, Canada, 2017-2018

Abstract

Background: Despite increasing prevalence of illicit fentanyl use in the US and Canada, preference for fentanyl over other illicit opioids has not been fully characterized. Therefore, we sought to describe changes in illicit opioid preferences over time among people who inject drugs (PWID). Methods: Data were obtained from two prospective cohort studies between 2017 and 2018. Trends in opioid preference over time were examined using bivariable generalized estimating equation (GEE) analysis. Multivariable models were used to identify factors associated with fentanyl preference. Results: Among 732 eligible participants, including 425 (58%) males, the prevalence of preference for fentanyl increased from 4.4% in 2017 to 6.6% in 2018 (Odds Ratio [OR] = 1.27, 95% Confidence Interval [CI]: 1.05–1.52). In a multivariable analysis, younger age (Adjusted Odds Ratio [AOR] = 0.94, 95% CI: 0.92–0.96) and daily crystal methamphetamine injection (AOR = 1.68, 95% CI: 1.01–2.78) were independently associated with preference for fentanyl. The most common reasons for preferring fentanyl included “better high than other opioids” (45%), and “lasts longer than heroin” (27%). Conclusions: The current study has demonstrated that preference for fentanyl has been increasing over time among our sample of PWID who use opioids. Further work is needed to clarify risk factors surrounding transitions to illicit fentanyl.

Keywords:

• Fentanyl
• overdose
• drug preference
• opioids
• people who use drugs

Disclosure statement

EW has a part-time appointment as the Chief Medical Officer with Numinus, a company that operates a testing and research lab facility and works toward potential addiction treatment and other therapeutic applications of psychedelic substances. MJM’s institution has received an unstructured gift from NG Biomed, Ltd., to support his research. MJM is the Canopy Growth professor of cannabis science at the University of British Columbia, a position created by unstructured gifts to the university from Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia’s Ministry of Mental Health and Addictions. Neither of EW’s employer or the funder that supports MJM had any role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication. No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff. This project was supported by the US National Institute on Drug Abuse (NIDA) [R25-DA037756, U01DA038886, U01DA02152]. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine which supports EW and the Canadian Institutes of Health Research (CIHR) Canadian Research Initiative on Substance Misuse [SMN–139148]. KH holds the St. Paul’s Hospital Chair in Substance Use Research and is supported in part by the NIDA grant [U01DA02152], a CIHR New Investigator Award [MSH-141971], a Michael Smith Foundation for Health Research (MSFHR) Scholar Award, and the St. Paul’s Foundation. M-JM is supported by the NIDA grant [U01-DA021525], a CIHR New Investigator award and a MSFHR Scholar Award. This work was also supported by National Institutes of Health.