Estimating the Risk of Exposure to Fentanyl in New York City: Testing Drug Residue in Used Syringes

Objectives. To estimate the risk of exposure to fentanyl among syringe exchange program (SEP) participants in New York City. Methods. We recruited a convenience sample from 11 SEPs in New York City between March and June 2017. Consenting participants (n = 434) received a labeled syringe for their next injection. We tested collected syringes with gas chromatography-mass spectrometry and liquid chromatography-quadrupole-time-of-flight mass spectrometry. Fentanyl or fentanyl analogs detected in quantities greater than 10% of the residue mass were reported. Results. The Final analysis included 271 syringes; 46 (17.0%) contained Fentanyl or a fentanyl analog. Fentanyl was the most frequently identified fentanyl compound, identified in 36 (13.3%) syringes. Furanyl-fentanyl was detected in 10 (3.7%) syringes, and 4-fluoroisobutyryl Fentanyl was detected in 5 (1.8%) syringes. Conclusions. The risk of exposure to fentanyl in syringes used by SEP participants was significantly lower significantly lower than the amount of fentanyls identified among overdose decedents in New York City. Further research is needed to understand how people who use drugs have adapted to fentanyl in the drug market. Understanding the risk of exposure to fentanyls is critical to development of targeted public health messaging.