Half of the participants in opioid substitution programs also tested positive for fentanyl at some point during a five-month period, indicating that they were using drugs besides the methadone, suboxone or prescribed heroin provided to them for addiction treatment, according to new research published today.
William Honer
“Our results show that for this group of people, substitution treatment is not the full answer,” said William Honer, Professor and Head of the Department of Psychiatry and senior researcher with the Provincial Health Services Authority’s BC Mental Health and Addictions Research Institute. “Many of these people have co-occurring mental illnesses, about half with psychosis and one-third with mood disorders, so we need to think of a more comprehensive treatment strategy that includes — but goes beyond — addressing the drug use.”
The study, published Jan. 31 in JAMA Psychiatry, looked at the presence of the drug in people living in marginal housing in the Downtown Eastside to better understand the level of risk for that community. Dr. Honer and his colleagues asked research participants to provide urine samples.
Between March and July 2017, the researchers found traces of fentanyl in 39 per cent of the community residents who were tested. Of those enrolled in opioid substitution programs, fentanyl was found in 52 per cent.
The results indicate that people in substitution programs sometimes seek out other drugs, perhaps because they missed their scheduled doses. Those other drugs are now more likely to include higher potency opioids like fentanyl. Dr. Honer says the results are concerning because people exposed to fentanyl build up a higher opioid tolerance, which may make the substitution programs less effective.
Among those who said they were opioid users, positive tests for fentanyl jumped from 45 per cent at the beginning of the study to 100 per cent by the end.
“Our report shows how quickly things can change,” said Dr. Honer, the Jack Bell Chair in Schizophrenia. “High-risk drugs can enter the distribution systems very quickly.”
However, Dr. Honer noted that the community studied “is not representative of the whole Canadian population of opioid users. Many come from lives filled with adversity, and the average user first took heroin in their late teens. We have to look community-by-community to understand the local needs and how best to provide treatment.”
The study was funded by the Canadian Institutes of Health Research and BC Mental Health and Substance Use Services, an agency of the Provincial Health Services Authority.
“This study has practical implications for the assessment and treatment for people who use opioids,” said Jehannine Austin, executive director of PHSA’s BC Mental Health and Addictions Research Institute and Associate Professor of Psychiatry and Medical Genetics. “We support clinically oriented mental health and substance use research across the lifespan with a focus on connecting research back to our participants in ways that improve outcomes for them and their communities.”