Awareness of fentanyl exposure and the associated overdose risks among people who inject drugs in a Canadian setting

Introduction and Aims: Illicitly-manufactured fentanyl continues to fuel the opioidoverdose crisis throughout the United States and Canada. However, little is known about factors associated with knowingly or unknowingly using fentanyl. Therefore, we sought to identify the prevalence and correlates of suspected/known and unknown exposure to fentanyl (excluding the prescribed one) among people who inject drugs (PWID), including associated overdose risks. Design and Methods: Data were derived from three prospective cohort studies of community-recruited people who use drugs in Vancouver, Canada in 2016–2017. Multivariable logistic regression was used to identify correlates of suspected/known exposure (i.e., urine drug screen positive [UDS+] and self-reporting past three-day exposure) and unknown exposure to fentanyl (i.e., UDS+ and self-reporting no past three day exposure), respectively. Results: Among 590 PWID, 296 (50.2%) tested positive for fentanyl. Of those, 143 (48.3%) had suspected/known and 153 (51.7%) had unknown exposure to fentanyl. In multivariable analyses, using supervised injection sites and possessing naloxone were associated with both suspected/known and unknown exposure (all p