Estimating the Risk of Exposure to Fentanyl in New York City: Testing Drug Residue in Used Syringes

Abstract

Objectives. To estimate the risk of exposure to fentanyl among syringe exchange program (SEP) participants in New York City. Methods. We recruited a convenience sample from 11 SEPs in New York City between March and June 2017. Consenting participants (n = 434) received a labeled syringe for their next injection. We tested collected syringes with gas chromatography–mass spectrometry and liquid chromatography–quadrupole–time-of-flight mass spectrometry. Fentanyl or fentanyl analogs detected in quantities greater than 10% of the residue mass were reported. Results. The final analysis included 271 syringes; 46 (17.0%) contained fentanyl or a fentanyl analog. Fentanyl was the most frequently identified fentanyl compound, identified in 36 (13.3%) syringes. Furanylfentanyl was detected in 10 (3.7%) syringes, and 4-fluoroisobutyryl fentanyl was detected in 5 (1.8%) syringes. Conclusions. The risk of exposure to fentanyl in syringes used by SEP participants was significantly lower significantly lower than the amount of fentanyls identified among overdose decedents in New York City. Further research is needed to understand how people who use drugs have adapted to fentanyl in the drug market. Understanding the risk of exposure to fentanyls is critical to development of targeted public health messaging.

Gas Chromatography-Mass Spectrometry Analysis of Synthetic Opioids Belonging to the Fentanyl Class: A Review

“…Early testing of fentanyl confirmed its ability to cause rapid anesthetic effects while more importantly causing minimal effects on the cardiovascular system of the patient. [56,57] Due to its potency and ease of manufacture, fentanyl has been involved in a number of deaths involving its illicit trafficking and use in Australia [33] and within the United States [58,59] in Michigan, [32] New Mexico, [60] Florida and Ohio, [61,62] New York [63] and Rhode Island [64] just to name a few. The original Janssen synthesis of fentanyl featured five steps and it would provide a blueprint to be followed by subsequent synthetic efforts that methodically refined or improved existing yields in this route, making use of the commercial availability of new intermediates or more efficient methodologies that appeared in the literature over time.…”

The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies

“…Fentanyl is ~30–50 times more potent than heroin, and smaller volumes of heroin and other drugs that are adulterated with fentanyl can produce powerful effects with lower production costs. Detecting fentanyl and its analogs in used syringes can reveal exposure risk 35 . The fentanyl detection rate was significantly higher among drug users who injected drugs in the past 6 months compared with non-injection drug users.…”

Which illicit drugs are injected in Oslo? A study based on analysis of drug residues in used injection equipment and self-reported information

“…In previous studies assessing drug residues, only remains found in the used syringe barrels were analysed [ 18 – 25 ]. In Norway, it is substantially more challenging to find used syringe barrels than needles for analysis, as syringes in their entirety (barrels and needles) are returned to distribution points to a lesser extent.…”

“…Data collection is non-invasive, and the method has the potential to capture changes in the illicit market for injectable drugs and provide an opportunity to identify new psychoactive substances. The methodology has previously been used in some European countries, the USA and Australia [ 18 – 25 ]. Our study adds to the current literature by (a) presenting analytical results from drug residues collected in Oslo; (b) testing for 64 substances, including 24 fentanyls and six other opioids and (c) not confining analyses to drug residues from used syringe barrels only but also from used needles; and (d) comparing drug test results to self-reported information from PWID.…”