North America is in a state of crisis. Opioid addiction is rampant throughout the entire country, with recent data from the Public Health Agency of Canada (PHAC) finding that more than 10,000 Canadians have died from opioid overdoses over the period of 2016-2018. In trying to deal with this worsening crisis Canadian doctors, health providers and harm reduction organizations have had to implement responses to try and manage the use of opioids within their practices and many of them are using testing as part of their risk management protocol.
The Drug and Alcohol Testing Association of Canada (DATAC) conducted a national study throughout July and into August of 2019 to understand how these different clinical programs are dealing with opioid management. This study looked at over 100 various organizations that deal with the treatment of opioid addiction including Opioid Agonist Treatment Programs (OATP) (those that use methadone, or buprenorphine/naloxone), Pain Clinics, and Rehabilitation & Treatment Facilities. The study was done to give a picture of which opioids are of greatest concern within Canada, how facilities are testing for them as well as what variations there are across treatment facilities, and geographically. This study included data from five provinces, British Columbia, Alberta, Manitoba, Ontario, and New Brunswick, with the highest number of respondents, 85%, coming from Ontario.
The study looked at the types of opioids, specifically, that each organization is most concerned with and whether or not they are doing drug testing to monitor the use of the drugs, and what kind of testing they are using to monitor use. There are patterns that can be seen across the types of organization as well as those that speak to the varying, specific drug concerns which are apparent in the different Canadian communities. Of those who responded 97% are actively engaged in drug screening their patients and out of that group, 99% perform the screening onsite.
The most tested for opioid nationally was fentanyl with just over 85% of the respondents indicating that it appeared on the drug panel they used to screen patients, with heroin being the second most commonly screened for drug at 46%. When looking at the differences according to regions we can see which drugs are of more concern in each province; New Brunswick clinics were the only province within the study that did not test for fentanyl, instead of concentrating solely on heroin. Manitoba and Ontario, on the other hand, were the only two which had hydromorphone as their second most commonly screened for opioid, following fentanyl. In addition to opioids, the most prevalent drugs of concern across all respondents included cocaine (74.1%), cannabis (70.4%), methamphetamine (70.4%) and alcohol (55.6%).
The study was also interested in how the clinics were choosing to do their drug testing, as to what form of test kits they were using and whether or not they are following up screens with laboratory confirmation testing. 30.4 % of the respondents indicated that they used more than one set of test panels, depending on the situation with each particular patient. The most common test format, used by 81.4% of respondents, was urine test dips, with the next most common test type, urine test cups, being used by 20.6% of those who took part in the study.
A key observation we can come away with from this, DATAC’s inaugural National Opioid Management Study, is that fentanyl is clearly a major concern nationally, and is being tested for in nearly all settings. This information is in keeping with data from the government of Canada, which reported that 82% of accidental opioid-related deaths in 2019 (Jan. – Mar.) involved fentanyl or fentanyl analogues, underscoring the need for continued action. DATAC expects that this study will be done annually to provide ongoing insight into how clinical practices and market influences are evolving. If you are interested in reading the full report, you can find it here.