You can’t see it, smell it or taste it, but fentanyl is deadly. In the first three months of 2018, the Canadian government recorded almost 1,000 accidental opioid-related deaths. Almost three quarters of these involved fentanyl, double the number from the same period in 2016.
Illicitly manufactured fentanyl is extremely potent, and only a tiny amount of the drug, or a fentanyl analogue, can cause overdose and death. Increasingly, the synthetic opioid is found in street drugs from cocaine to heroin and counterfeit pills, putting drug users at increased risk of overdose.
As the overdose crisis shows no signs of abating, researchers are looking for harm reduction solutions, including ways to help drug users understand more about what they are putting into their bodies. According to new research, fentanyl test strips could be one way of helping people who use drugs detect fentanyl and change their consumption behaviour to reduce overdose risk.
The pilot study followed 93 self-reported users of heroin, cocaine, or illicitly obtained prescription pills aged 18 to 35 in Rhode Island, USA, an area that has been severely affected by the opioid epidemic. Participants were provided with 10 rapid fentanyl test strips and a naloxone kit, a medication that can block the effects of an opioid overdose. They were also given overdose prevention information on how to safely use drugs (such as not drugs using alone, keeping naloxone nearby, and titrating doses).
The rapid fentanyl test strips work like an over-the-counter pregnancy test. A minute after dipping a test strip into water containing a small amount of the drug, or urine post-consumption, either one or two red lines appear. One line means the liquid contains fentanyl, and two lines means the test did not detect the drug.
Of the 81 participants who returned for follow-up in the study, 77% had used at least one strip, and half of those had detected fentanyl in their drug supply. Although few reported discarding fentanyl-laced drugs, participants did report adapting their behaviour to reduce the risk of overdose, including using smaller amounts (45%), proceeding more slowly when using (42%), and using with someone else present (39%).
Mark Lysyshyn, medical health officer at Vancouver Coastal Health and one of the study’s co-authors, told the Globe and Mail that the checks serve not to prove the safety of an illicit drug, but to provide people who use drugs with more information about the substances they choose to ingest.
In Vancouver, where fentanyl test strips are offered as part of some overdose prevention programs and even found on shelves at local Dollar Stores, there is a growing appetite for test strips. However, there are also concerns over the accuracy of non-validated strips, particularly as many are only designed for detecting fentanyl in urine, making them usable only after ingestion.
Nonetheless, with almost all study participants wanting to continue using the test strips, and many distributing ‘spare’ strips to others, fentanyl test strips could provide a cheap and effective layer of protection against overdose among young people who use drugs.