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However, little is known about factors associated with knowingly or unknowingly using fentanyl. Therefore, we sought to identify the prevalence and correlates of suspected\/known and unknown exposure to fentanyl (excluding the prescribed one) among people who inject drugs (PWID), including associated overdose risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were derived from three prospective cohort studies of community\u2010recruited people who use drugs in Vancouver, Canada in 2016\u20132017. Multivariable logistic regression was used to identify correlates of suspected\/known exposure (i.e. urine drug screen positive and self\u2010reporting past 3\u2010day exposure) and unknown exposure to fentanyl (i.e. urine drug screen positive and self\u2010reporting no past three\u2010day exposure), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 590 PWID, 296 (50.2%) tested positive for fentanyl. Of those, 143 (48.3%) had suspected\/known and 153 (51.7%) had unknown exposure to fentanyl. In multivariable analyses, using supervised injection sites and possessing naloxone were associated with both suspected\/known and unknown exposure (all <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.05). Injecting drugs alone (adjusted odds ratio 3.26; 95% confidence interval: 1.72\u20136.16) was associated with known exposure, but not with unknown exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>We found a high prevalence of fentanyl exposure in our sample of PWID, with one half of those exposed consuming fentanyl unknowingly. While those exposed to fentanyl appeared more likely to utilise some overdose prevention services, PWID with suspected\/known fentanyl exposure were more likely to inject alone, indicating a need for additional overdose prevention efforts for this group.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.13261","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T21:59:37Z","timestamp":1613858377000},"page":"964-973","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Awareness of fentanyl exposure and the associated overdose risks among people who inject drugs in a Canadian setting"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3843-2928","authenticated-orcid":false,"given":"Kanna","family":"Hayashi","sequence":"first","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"Faculty of Health Sciences Simon Fraser University  Burnaby Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Wood","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"Department of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiru","family":"Dong","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"School of Population and Public Health University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane A.","family":"Buxton","sequence":"additional","affiliation":[{"name":"School of Population and Public Health University of British Columbia  Vancouver Canada"},{"name":"British Columbia Centre for Disease Control  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4195-3284","authenticated-orcid":false,"given":"Nadia","family":"Fairbairn","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"Department of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8775-7142","authenticated-orcid":false,"given":"Kora","family":"DeBeck","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"School of Public Policy Simon Fraser University  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3821-6221","authenticated-orcid":false,"given":"M.\u2010J.","family":"Milloy","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"Department of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0870-7153","authenticated-orcid":false,"given":"Thomas","family":"Kerr","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver Canada"},{"name":"Department of Medicine University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aau1184"},{"key":"e_1_2_7_3_1","unstructured":"Public Health Agency of Canada.Opioid\u2010related harms in Canada(2020). Available at:https:\/\/infobase.phac-aspc.gc.ca\/datalab\/national-surveillance-opioid-mortality.html#AORD(accessed June 2020)."},{"key":"e_1_2_7_4_1","volume-title":"Illicit drug toxicity deaths in BC: January 1, 2010\u2014March 31, 2020","author":"British Columbia Coroners Service","year":"2020"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm675152e1"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.38.6.05"},{"key":"e_1_2_7_7_1","unstructured":"BC Government News.Provincial health officer declares public health emergency.2016; Available at:https:\/\/news.gov.bc.ca\/releases\/2016HLTH0026-000568(accessed May 2020)."},{"key":"e_1_2_7_8_1","unstructured":"Province of British Columbia.Overdose prevention. 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