Discordance between Self-reported and Biologically Tested Exposure to Fentanyl among People at Risk of Opioid Overdose

Abstract

Drug overdose remains a leading cause of death in the US, and the majority of opioid overdose fatalities involve fentanyl. This study aims to measure the degree of concordance between self-reported and biologically tested exposure to fentanyl. We conducted a cross-sectional analysis using survey and urinalysis data collected between 2019 and 2020 from Anne Arundel County, Maryland. Among urinalysis participants (n=113), 30% reported daily fentanyl use, and among this group, only 54% had a fentanyl-positive result. Cohen’s Kappa between self-reported and biologically detected fentanyl use was 0.26, indicating minimal agreement between the two markers. Limitations to interpreting self-reported and urinalysis data are discussed in this report.