This article is more than 5 years old. Information may no longer be current.
Concomitant fentanyl, cocaine use skyrockets 1850% from 2013 to 2018
Click Here to Manage Email Alerts
The number of cocaine-positive urine drug test specimens that were also positive for nonprescribed fentanyl increased by 1,850% from 2013 to 2018, according to study results published in JAMA Network Open.
Among urine drug test specimens positive for methamphetamines, the number also positive for fentanyl increased by 798% in the same time period.
“Drug overdose deaths continue to rise, despite efforts aimed at preventing prescription opioid misuse and abuse. While fentanyl has been identified as the most common contributor, cocaine- and methamphetamine-related overdose deaths have also increased substantially,” Leah LaRue, PharmD, PMP, from Millennium Health in San Diego, told Healio Psychiatry. “There is growing concern that concomitant exposure to fentanyl may also play a role in these stimulant-related deaths, knowingly or unknowingly to the user.”
The investigators examined whether the prevalence of positive results for nonprescription fentanyl changed among urine drug test (UDT) results positive for cocaine or methamphetamine between Jan. 1, 2013, through Sept. 30, 2018 in patients from health care practices across the U.S.
“Identifying shifting trends in drug use provides additional insight to clinicians, public health agencies, and policy makers working in communities to curb drug overdose and deaths,” LaRue said.
UDT analysis detected benzoylecgonine (cocaine metabolite), methamphetamine, fentanyl and norfentanyl. Any individuals who reported prescription fentanyl were excluded. Using a convenience sample approach, 1 million unique patient UDT specimens from Millennium Health’s UDT database were analyzed for combinations of cocaine and fentanyl or methamphetamine and fentanyl.
Most patients received treatment at pain management practices (33.5%), by primary care practices (23.7%) or at substance use disorder treatment centers (20%). LaRue and colleagues found that the total positivity rates were 4% for cocaine, 3.1% for methamphetamine and 1.4% for fentanyl. Over the nearly 6-year period, trend tests indicated significant increases in nonprescribed fentanyl positivity in UDT results for both cocaine- and methamphetamine-positive specimens.
The results showed that positivity rates for nonprescribed fentanyl in the cocaine-positive and methamphetamine-negative results group skyrocketed 1,850% (P < .001) from 0.9% (n = 84; 95% CI, 0.7-1.1) in 2013 to 17.6% (n = 427; 95% CI, 16.1-19.1) in 2018. In addition, positivity rates for nonprescribed fentanyl in the methamphetamine-positive and cocaine-negative results group rose 798% (P < .001) from 0.9% (n = 29; 95% CI, 0.6-1.2) in 2013 to 7.9% (n = 344; 95% CI, 7.1-8.7) in 2018.
Subanalysis of 2018 data showed that UDT results from patient specimens collected from substance use disorder treatment centers had the highest rate of nonprescribed fentanyl positivity in cocaine (28.8%; 95% CI, 26.1-31.7) and second highest rate in methamphetamine (10.4%; 95% CI, 9.1-11.8).
“Clinicians and patients should be aware of the increased risk for overdose with the combination of fentanyl and a stimulant and take necessary precautions to maximize safety,” LaRue told Healio Psychiatry. – by Savannah Demko
Disclosure: LaRue is an employee of Millennium Health. Please see the study for all other authors’ financial disclosures.