Fentanyl Use

People with prescription-type opioid use disorder who had urine drug screen test that was positive for fentanyl at the start of the trial (baseline).

Fentanyl-exposed participants were more likely to be younger, to self-identify as non-white, to be unemployed or homeless and to be currently using stimulants than non-fentanyl-exposed participants.

To determine if fentanyl exposure at baseline impacted whether OPTIMA trial participants started or stopped medications for opioid use disorder (MOUD).

In other words, is fentanyl exposure a predictor of initiation and/or discontinuation of medications for opioid use disorder. Specifically, flexible buprenorphine/naloxone or methadone.

They compared the number of participants who were exposed to fentanyl when they first joined the study to:

a) whether they started a medication for opioid use disorder

b) time it took to be assigned to either the flexible BUP/NAL group or methadone group

c) time to stop/discontinue overall medications for opioid use disorder

Participants that were exposed to fentanyl were:

• less likely to start treatment (OR=0.18)

• stayed in the assigned treatment group for a shorter amount of time (20 days vs. those that were not exposed to fentanyl stayed with their assigned treatment for an average of 168 days).

• stayed on any medication for opioid use disorder for a shorter amount of time (27 days versus 168 days for those that were not exposed to fentanyl)

Both flexible buprenorphine/naloxone and methadone may be appropriate treatment options for people with prescription-type opioid use disorder regardless of fentanyl exposure. Other characteristics of fentanyl-exposed individuals appear to be driving the association with reduced initiation and continuation with treatment.