Epidemiology in Community Health Nursing of Fentanyl
| Updated: Sept 12th, 2024 |
The paper, “Changes in drug use behaviors coinciding with the emergence of illicit fentanyl among people who use drugs in Vancouver, Canada” by Brar and colleagues (2020) highlight how drug users’ habits in Vancouver, Canada, changed in tandem with the appearance of illegal fentanyl. A potent synthetic opioid, fentanyl, is increasingly present in Canada’s black-market drug market and has been linked to increased overdose fatalities. The paper highlights the skyrocketing percentage of people using fentanyl over the last decade. Specifically, between 2014 and 2018, the rate of opioid users who also reported taking fentanyl grew from 4% to 67%. The paper involved participants with at least one follow-up appointment between December 2013 and June 2018. As the authors point out, the increasing availability of fentanyl in the illegal drug supply has likely prompted a shift toward more regular and injection-based opiate usage. The authors also stress the need for harm reduction strategies like naloxone distribution and supervised consumption facilities to combat the fentanyl overdose epidemic.
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Type of Study
Brar et al. (2020)’s research is a longitudinal cohort study. Longitudinal studies involve a research design in which researchers track a group of people throughout time to gather information at regular intervals. Additionally, the research involves data from the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to assess exposure to survival services. The study participants provided signed informed consent forms, and they had to be at least 18 years old and current illicit drug users for inclusion in the trials. The researchers used a cohort study that followed subjects throughout time due to the recent appearance of illegal fentanyl in Vancouver’s drug supply. Longitudinal cohort study helps the researchers determine how people’s drug-using habits have changed. In essence, the researchers tracked drug users to understand how subjects’ habits changed as fentanyl became more widely available. The study’s longitudinal cohort approach was well-suited to answering the research topic and providing insight into how drug users in Vancouver, Canada, have changed their habits over time. In a different context, it is arguable that the authors saved time and money by drawing on preexisting cohort studies rather than beginning a new one from scratch. In the precepts, attrition bias became a potential issue throughout the study, which occurs when former research members have different characteristics or results than current study participants. Accordingly, the authors used statistical approaches to control for possible confounding factors and to account for missing data.
Findings
The results published in the research align with what I know about fentanyl’s proliferation in Canada’s illegal drug supply and the subsequent increase in overdose fatalities. Since 2012, fentanyl’s presence in the illicit drug market in Canada has increased, leading to a dramatic rise in overdose fatalities. Brar and colleagues’ report underpins the information I have concerning the percentage of individuals reporting fentanyl usage significant increment over time, as did the percentage reporting daily opioid use and the percentage reporting opioid use other than injection. These results align with expectations in a dynamic drug supply, where introducing a more potent and deadly substance would cause users to alter their behavior. This study’s results align with those of other studies that have examined how fentanyl affects drug usage patterns and the likelihood of an overdose. For instance, Park et al. (2019) observed that drug users exposed to fentanyl were likelier to overdose in the future and that this risk was much higher for injectors. Similarly, Han et al. (2019) discovered that fentanyl users had a greater propensity to report injectable drug usage, poly-substance use, and an elevated risk of overdose.
The danger of overdosing from illegal fentanyl is significantly increased when combined with other substances like heroin, cocaine, or methamphetamine. Given the pharmacological qualities of fentanyl and the nature of drug use behaviors, the documented connections between the introduction of fentanyl and changes in drug use behaviors among persons who use drugs in Vancouver make sense. Users of fentanyl may only need to take a small quantity to feel its effects, but they are still in increased danger of an overdose because of the drug’s extreme potency (Zoorob, 2019). Moreover, fentanyl’s quick onset and brief duration of effect may encourage repeated doses, which in turn promotes more frequent and injectable drug usage.
Level of Association
The magnitude of the effect sizes presented in the research may be used to evaluate the robustness of the observed connection between the appearance of fentanyl and changes in drug use behaviors among persons who use drugs in Vancouver. The adjusted odds ratio (AOR) for reporting fentanyl usage ranged from 1.80 to 2.88, showing a substantial rise in the percentage of individuals reporting fentanyl use over time. According to the results, there is a significant correlation between the increase in fentanyl and fentanyl usage among the study population. Concerning the percentage of people in the survey using the drug, this research shows a moderate to a substantial positive correlation between the advent of fentanyl and changes in study members’ opiate usage patterns. An increasing percentage of research participants reported using fentanyl, daily opioids, and injectable drugs during the trial, indicating that the observed relationships were moderate to strong. These results imply that fentanyl’s arrival has significantly affected drug users’ practices in Vancouver. They call attention to the need for measures to mitigate the risks posed by this constantly shifting drug supply. Nevertheless, it should be noted that this research was done on a particular group of Vancouver drug users and may not apply universally.
Incorporation
I would incorporate the findings of the research community health nursing practice. Results from this research may improve community health nursing practice and the development of health promotion initiatives in any community where changes in drug use habits have coincided with the introduction of illegal fentanyl. There has been a dramatic rise in fatalities and injuries caused by drug overdoses in my community and other countries where fentanyl is widely used. Implementing the study’s results into community health nursing practice may assist in enhancing drug users’ health outcomes and lessen the risks connected with fentanyl use.
Community health nurses may use the results of this research to implement programs designed to lessen potential adverse outcomes from fentanyl usage. Safer drug use habits, such as overdose prevention kits and safer injecting procedures, might be promoted by providing users with information and access to services. Naloxone, a medicine used to reverse the effects of an opioid overdose, may be distributed to people who use drugs. Community health nurses can cooperate with local agencies and groups to make this happen. The study’s results on rising rates of daily opioid and injectable drug use also stress the need to provide thorough addiction therapy that addresses the disease’s physical and psychological elements. Community health nurses may work with addiction treatment providers to ensure drug users can access effective treatments, including medication-assisted therapy (MAT) and behavioral therapies. Further, the study’s results on the gradual decline in non-injection opioid usage may help guide community health nursing practice in encouraging the use of oral drugs as an alternative to injection (Moallef et al., 2019). Overdose and the spreading of hepatitis and other blood-borne diseases are risks linked with injecting drugs, but this practice may help mitigate both.
The results of this research may be applied to the field of community health nursing by creating harm reduction initiatives, expanding addiction treatment services, and advocating for safer drug use behaviors. Essential insights into the impact of fentanyl on drug use behaviors and the need for comprehensive harm reduction and addiction treatment services are provided in this study, making it highly recommended for dissemination to other healthcare professionals, policymakers, and community organizations working in the field of drug addiction and harm reduction.
Research Questions
While the research answers many concerns, others still need to be addressed about how drug users in Vancouver have changed their behavior in response to the arrival of fentanyl. First, How do shifts in drug-using behavior vary among various groups of persons who partake in drug abuse? It would be fascinating to see whether the results of the Brar et al. research, which focused on drug users in Vancouver, are also valid for users in other parts of the world. Second, why has fentanyl’s popularity risen among drug addicts, and what elements are at play here? The percentage of subjects who admitted to using fentanyl increased significantly during the trial, but the research failed to highlight what was driving that growth. To curb the rising abuse of fentanyl, more investigation into the causes of this epidemic is needed, allowing for the design of more specific treatments to combat these issues. Furthermore, can the risks of fentanyl consumption be mitigated by harm reduction strategies? It is unclear how successful harm reduction measures are in minimizing the hazards connected with fentanyl use, despite their widespread usage. Overdose prevention kits and naloxone distribution programs are two examples of harm reduction treatments that might be studied in the future to see whether they are beneficial in lowering the risks of fentanyl use. Lastly, what changes may be made to the delivery of addiction treatment services in light of the ever-changing nature of the drug supply? Both opioid and injectable drug usage were shown to have increased throughout the research, highlighting the need to provide comprehensive addiction treatment.
References
Brar, R., Grant, C., DeBeck, K., Milloy, M. J., Fairbairn, N., Wood, E., … & Hayashi, K. (2020). Changes in drug use behaviors coinciding with the emergence of illicit fentanyl among people who use drugs in Vancouver, Canada. The American journal of drug and alcohol abuse, 46(5), 625-631.
Han, Y., Yan, W., Zheng, Y., Khan, M. Z., Yuan, K., & Lu, L. (2019). The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies. Translational psychiatry, 9(1), 282.
Moallef, S., Nosova, E., Milloy, M. J., DeBeck, K., Fairbairn, N., Wood, E., … & Hayashi, K. (2019). Knowledge of fentanyl and perceived risk of overdose among persons who use drugs in Vancouver, Canada. Public Health Reports, 134(4), 423-431.
Park, J. N., Sherman, S. G., Rouhani, S., Morales, K. B., McKenzie, M., Allen, S. T., … & Green, T. C. (2019). Willingness to use safe consumption spaces among opioid users at high risk of fentanyl overdose in Baltimore, Providence, and Boston. Journal of urban health, 96, 353-366.
Zoorob, M. (2019). Fentanyl shock: The changing geography of an overdose in the United States. International Journal of Drug Policy, 70, 40-46.
