Fentanyl test strips encourage caution among drug users

NEW YORK – The new opioid overdose tool is a cheap test strip that can help heroin users detect a potentially deadly contaminant in their medications.

Sales of fentanyl test strips have exploded as an increasing number of overdose prevention programs distribute them to users of illicit drugs.

Although not designed for this purpose, test strips can report the presence of fentanyl in illicit drugs. Some health officials question their accuracy, but they have proved so popular that some programs can not get enough to meet the demand.

"As soon as I'm on the street with them, they are gone," said Washington, DC, Maurice Abbey-Bey, who is in charge of needle exchanges.

The United States is at the heart of the deadliest drug overdose epidemic in its history, and the situation is getting worse. According to preliminary figures from the US government, more than 70,000 Americans died of a drug overdose last year, an increase of 10% over the previous year.

An increasing number of recent deaths have been attributed to fentanyl, an analgesic, and fentanyl-like drugs. Drugs are much more powerful than heroin, but they are relatively cheap and more and more often providers are reducing them to drugs, away from buyers.

The bands are selling for $ 1 each. The costs can add up quickly for the groups that distribute them, because some people use drugs four or five times a day.

Government agencies have started paying for test strips and using them for needle exchange programs. The state health department in California began last year and the health departments of some cities – including Philadelphia and Columbus (Ohio) – have since been created.

But other health organizations have declined the invitation, fearing that the tests are accurate or are not wondering if someone would actually throw contaminated drugs.

Catherine McGowan, assistant professor at the London School of Hygiene and Tropical Medicine, has done little research to determine whether test strips are an effective weapon against the overdose epidemic.

"Anything that allows people who inject drugs to reduce their own risks is a good thing," said McGowan. "You just have to be very careful."

L & # 39; ORIGIN

The test strips are designed to test the urine of patients to whom fentanyl is legally prescribed, so that doctors can make sure that they are taking the medicine well, said Iqbal Sunderani, general manager. BTNX, the Canadian band producer.

Bands are permitted for this purpose – and only for this purpose – in Canada. They are not licensed for any use in the United States.

In 2016, a Canadian doctor developed a new way to apply them: by dipping them into the residue of "cooker" cups used by heroin users to prepare their injections.

A government-approved, government-approved facility in Vancouver that allows people to use medications under medical supervision began testing two years ago. Last year, health officials released the results of a study involving more than 1,000 drug checks. More than 80% of the heroin and crystal meth samples were fentanyl positive, as were 40% of the cocaine samples.

The study found that drug users who tested positive were 10 times more likely to reduce their dose.

GROWTH OF INTERESTS

Vancouver's results attracted attention. In October 2016, the St. Ann's Corner of Harm Reduction in New York became one of the first US programs to offer them.

It was important to take further action, said Van Asher, head of the Bronx Syringe Access Program.

"We are losing more people than we were at the height of HIV" in the early 1990s, he said.

Some small studies have shown that drug users are very willing to use the tests. The most important is perhaps a study by researchers at Johns Hopkins and Brown Universities, which was not published in a peer-reviewed journal but was released in February.

He concluded that the test strips were very accurate.

BTNX does not recommend test strips for illicit drug testing, but Sunderani, the president of the company, knows it has become the main driver of sales.

He sold 117,000 tests in the United States last year. So far this year, he has already sold more than 410,000, he said.

Doublers

More and more government agencies in Canada and the United States are paying for the bands, but others are hesitant.

Dr. Elinore McCance-Katz, an influential figure in the Trump administration's response to the country's opioid epidemic, has expressed concern that positive test results will deter people from making waves.

"I do not think they're going to use fentanyl test strips and say," Oh yes, it's positive for fentanyl? I'd better find something else, "said McCance-Katz, who heads the US administration for addictions and mental health.

Striptease supporters agree that most heroin addicts will never give up on drugs, regardless of the test result.

"All this time, only three people have thrown away positive samples," said Tino Fuentes, an overdose prevention officer who has become a sort of Johnny Appleseed in the United States for test strips. promoting and distributing them in several cities.

But Fuentes and others believe that the strips can still lead people to reduce the risk of fatal overdose, for example by taking smaller doses or taking drugs in the presence of a person who has a drug reversing overdose .

Fuentes said he was delighted to learn that two people had recently stopped using the strips because they had decided to treat each dose as contaminated and take precautions every time.

"The ideal is to no longer need strips because people use them safely," he said.

NEGATIVE FALSE

Some health officials are concerned that test strips may not detect some contaminants. At the end of last year, the National Health Agency of Canada announced that a preliminary analysis of 70 samples revealed three cases in which the test failed to detect fentanyl or fentanyl. A follow-up analysis by Health Canada found that BTNX strips produced five false negatives out of 364 tested samples.

In Washington, DC, the health department refused to pay or approve their use "based on the high probability of false negatives," said department head Michael Kharfen.

Some social workers understand caution, noting, for example, that test strips detect the presence of fentanyl, but not in what proportion.

"It could be 2% or 98%. And the difference will kill you, "said Reilly Glasgow, who works at the Lower East Side Harm Reduction Center in New York City, part of an organization called Alliance for Positive Change.

But he said his program was finally persuaded to offer the bandages because too many people did not think that fentanyl could be taken in their medications.

"They needed proof," he said.

"THERE IS NO SECOND LINE"

Fentanyl contamination became so commonplace that a New York man joked that his drug addiction had become "a bit of heroin, but especially fentanyl".

The man claimed to have injected heroin since 1992 and spoke to The Associated Press on condition of anonymity because he did not want to compromise his ability to obtain housing, to stay in a homeless program. treatment or to get a job.

He said the test strips were hard to find, but he used them – usually when he was buying drugs from a new reseller. All these tests were positive. He said that he had still taken the drugs, starting with a lower dose called "screening test".

One day last month, he showed how the test strips worked on a packet of heroin powder stamped with a blue devil on his side, which he had bought from his usual dealer.

He called the dealer's product "consistently mediocre". It's a selling point, because it means he knows what he's earning "rather than playing Russian roulette".

In a Brooklyn apartment, he stirred the powder into a small cup, added water and sucked the resulting brown liquid into a syringe. Then he put the needle aside, added a few drops of water to what was left in the cup and swept it away.

He then dipped the end of a test strip to absorb water and drug residues. In a few seconds, a red line appeared. "He's supposed to be two. There is no second line, so it contains fentanyl, "he said.

Then he emptied the syringe into a vein on the back of his right hand, his eyes glazed as the drug took effect.

A friend, Jessie Kruger, arrived shortly after. Kruger stated that she was in the habit of injecting heroin but that she had quit smoking more than a year after an episode of scary health.

The test strips "are a godsend," said Kruger. "But it's important not only to do the test strip, but also to test, you can not test everything."

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