BACKGROUND It is unknown if targeted risk reduction counseling in the health care setting, after documented exposure to fentanyl, can affect behavior change to reduce risks and increase utilization of evidence-based overdose prevention strategies. METHODS We conducted a retrospective analysis of results (7/2018-6/2019) from questionnaire-facilitated counseling by recovery coaches in the emergency department (ED) and primary care settings following disclosure of a urine toxicology positive for fentanyl. RESULTS Seventy-five percent of N = 101 respondents were neither aware of nor expecting fentanyl in their substances of use. Fifty-three (70 %) of those initially unaware answered that learning about exposure to and the risks from fentanyl changed their thoughts about reducing or abstaining from use. A greater proportion of patients seen in the ED expressed desire to stop or reduce opioid use as compared to ambulatory clinic patients (91 % vs. 46 %, p < 0.001). Of those not already engaged in treatment, 18 % and 15 % were interested in medication and behavioural health treatment, respectively, and each of them indicated a change in thought based on the counseling. Forty-five percent of individuals not yet receiving naloxone endorsed interest in receiving it, and 22 % of all respondents were somewhat or very interested in access to safe consumption sites. CONCLUSION This study suggests a novel clinical utility in toxicology screens to inform behavior in the setting of illicit fentanyl exposure. In addition to linkages to evidence-based treatment, linkages to harm-mitigating strategies associated with ongoing substance use may be critical to a comprehensive overdose prevention strategy in the clinical setting.

中文翻译：

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尿液芬太尼阳性筛查对海洛因使用态度的影响。

背景技术尚无证据表明，在医疗保健机构中有针对性的降低风险咨询服务在记录到芬太尼暴露后能否影响行为改变以降低风险并提高循证用药过量预防策略的利用率。方法我们在对芬太尼呈阳性反应的尿毒理学资料披露后，对急诊科（ED）的恢复教练和初级保健机构提供的以问卷调查为基础的咨询结果进行了回顾分析（7 / 2018-6 / 2019）。结果N = 101的被调查者中有75％既不了解也不期望其使用物质中的芬太尼。最初不知道的人中有53（70％）回答说，了解暴露于芬太尼及其风险的做法改变了他们关于减少或放弃使用的想法。与非门诊门诊患者相比，急诊中看到更大比例的患者表示希望停止或减少阿片类药物的使用（91％比46％，p <0.001）。在尚未接受治疗的人中，分别有18％和15％的人对药物治疗和行为健康治疗感兴趣，他们每个人都根据咨询意见改变了想法。尚未接受纳洛酮的人中有百分之四十五表示愿意接受纳洛酮，而所有受访者中有22％的人对进入安全消费场所有些或非常感兴趣。结论这项研究建议在毒理学筛查中提供一种新的临床用途，以告知非法芬太尼暴露情况下的行为。除了与循证治疗相关联之外，