ID: HR19-1311

Presenting author: Jane A. Buxton

Presenting author biography:

No biography available.

Changing landscape of opioid use in British Columbia, Canada: A shift towards fentanyl-seeking behaviour

Kristi Papamihali, Brittany Graham, Alexis Crabtree, Christopher Mill, Mohammad Karamouzian, Margot Kuo, Sara Young, Jane A. Buxton


British Columbia (BC) declared a public health emergency in April 2016 in response to a rise in overdose deaths sue to increased prevalence of fentanyl-adulterated drugs.The BC Harm Reduction Program periodically surveys clients at harm reduction distribution sites across BC to assess substance use trends and uptake of harm reduction services. In February 2015, 13% of respondents reported using fentanyl while urinalysis detected fentanyl in a third. It is commonly suggested people are at risk of overdose through unknowingly using drugs contaminated with fentanyl. We aim to determine changes in intentional fentanyl use as well as elucidate discrepancies between self-report and actual drug use.


The client survey was distributed to harm reduction site clients over a two-month period in 2018. Quantitative survey data was analyzed using descriptive statistics and compared to previous survey data. Urine samples were collected from a subset of the participants and Toxicology Screens were performed by LifeLabs.


Surveys were obtained from 508 clients and urine samples from 320 participants across BC. Most common self-reported opioids used in the past week were heroin (49%) and fentanyl (43%). Conversely, urinalysis results demonstrated presence of heroin in 26% of participants and fentanyl in 58%. 39% of respondents indicated they would use the same amount if their drugs tested positive for fentanyl while 44% reported that they would use less. In the past 6 months: experiencing an accidental opioid overdose was reported by 18% of respondents; and 56% reported witnessing an opioid overdose.


Self-reported drug use and urinalysis identified discrepancies in what drugs people think they are using and what is actually being used. Intentional fentanyl use has tripled over 3.5 years.