• Mary Clare Kennedy, Huiru Dong, Samuel Tobias, Jane A Buxton, Mark Lysyshyn, Kenneth W Tupper, and Lianping Ti.
• School of Social Work, Faculty of Health and Social Development, The University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada. Electronic address: bccsu-mck@bccsu.ubc.ca.
• Am J Prev Med. 2024 Jan 1; 66 (1): 101710-17.

IntroductionThe proliferation of fentanyl and its analogs in illegal, unregulated drug markets remains a major driver of the overdose crisis in North America. Drug checking services have been implemented as a harm reduction strategy to address the crisis. However, little is known about their potential utility as a mechanism for monitoring population-level risk of overdose stemming from changing fentanyl concentration in unregulated drugs over time. Therefore, this study assessed the relationship between median fentanyl concentration in expected opioid drug checking samples and the death rate due to illicit drug toxicity over time in Vancouver, Canada.MethodsMonthly population-based rates of death due to illicit drug toxicity were drawn from provincial coroner records. Monthly median percent fentanyl concentration was calculated using a validated quantification model from point-of-care Fourier-transform infrared spectra among expected opioid samples that tested positive for fentanyl at community drug checking services. A time-series analysis using generalized additive modeling was conducted to examine the association between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, controlling for calendar month. Analyses were conducted in 2021-2022.ResultsBetween January 2019 and October 2020, 577 deaths due to illicit drug toxicity occurred in Vancouver, and the observed monthly rate ranged from 1.75 to 7.65 deaths per 100,000 population. A significant, positive association was observed between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, adjusting for calendar month (chi-square=52.21, p<0.001).ConclusionsFindings suggest a role for point-of-care drug checking as a tool for monitoring evolving overdose risk at the population level.Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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