Health care advocates want to put a cheap drug test in the hands of users to combat soaring rates of overdose deaths from the powerful synthetic opioid fentanyl, which is contaminating nearly every illegal drug on the street.
Originally intended to detect fentanyl presence in urine, tiny cardboard strips that cost about $1 are just as effective in detecting the synthetic opioid in drugs themselves, researchers have found.
“The point is that it allows people to make choices, to have a little more information,” said Susan Sherman, a professor in the department of health, behavior and society at Johns Hopkins University.
Ms. Sherman is the lead researcher of the Forecast study, which shows that the strips are sensitive enough to detect fentanyl in drugs. The study also has found that users are interested in testing the drugs.
“It’s not a small thing that people who are drug users feel a sense of autonomy, and it gives them a choice,” she said.
Fentanyl and its more powerful cousins are increasingly being detected in street drugs such as opioids, methamphetamine, cocaine, synthetic marijuana and benzodiazepines. After years of stability, overdose deaths from cocaine have almost tripled since 2013.
Last year, fentanyl and other synthetic drugs were involved in nearly 30,000 overdose deaths. Demand for the test strips has surged over the past year among state and county health departments and local activists.
Iqbal Sunderani, the CEO and founder of BTNX, a company that makes and sells drug testing kits, said sales have soared since 2016, when the only supervised injection site in Vancouver, British Columbia, started using the strips to test drugs.
“We were already selling these urine tests to the Vancouver health authority,” Mr. Sunderani said. “So they decided to experiment, to see if these tests could be used to detect fentanyl on the street — and it can.”
As word spread of the test strips, Mr. Sunderani said, sales exploded. From January to May, the company sold more than 410,000 strips in the U.S., twice as many as in all of 2017. At least 100,000 of those strips went to California, where the state’s health department has provided funds since last year for drug users to buy the strips.
New York City in July implemented a policy to help needle exchange programs integrate fentanyl test strips into their operations, and the University of Texas bought 37,600 strips across three campuses to be included with the overdose reversal medication naloxone in overdose prevention kits.
In Burlington, Vermont, and Columbus, Ohio, health care centers and syringe exchange programs are distributing the strips.
The strips work by mixing a small sample of the drug with some water and then applying the strip. One line appears if fentanyl is present, and two lines if it’s not.
But the results can be confusing to read, and the lines sometimes are faded or misinterpreted.
The strips also can’t tell how much fentanyl is present or whether the positive reading is for a similar drug. Carfentanil, for example, is 100 times more potent than fentanyl and 1,000 times more powerful than morphine.
“I don’t think the presence of fentanyl will stop people using the drugs,” said Paul A. LaKosky, executive director of the Washington-based North American Syringe Exchange Network. “I don’t necessarily think the fear or knowledge of fentanyl will not make you use it, but it might … make you be more careful when you use it.”
That is the message health officials want people to receive: If fentanyl is present, throw the drugs away. If you choose to go ahead, don’t shoot up alone, use only a little and make sure someone with you has naloxone.
“We want people to continue to stay alive until they’re ready to go into treatment,” said Dr. Mysheika Roberts, health commissioner of Columbus, Ohio, which bought 6,000 strips for distribution since August. “We feel like by giving them this resource to test their drugs to see if it has fentanyl in it, allows them to make a decision.”
But the Trump administration in October warned against using the strips.
“The entire approach is based on the premise that a user poised to take a drug is making rational choices, is weighing pros and cons, and is thinking completely logically about drug use. Based on my clinical experience, I know this could not be further from the truth,” Elinore F. McCance-Katz, assistant secretary for mental health and substance abuse at the Substance Abuse and Mental Health Services Administration, wrote in a blog post.
Dr. Roberts said Columbus health officials are conducting surveys of drug users who use the test strips. Of 20 responses, 75 percent of people changed their behavior after their drug tested positive for fentanyl — meaning they didn’t use the drugs, made sure someone with naloxone was present, or used only a little.
“Those are 15 individuals who could have overdosed and died,” she said. “I think that is very significant.”
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