Pubdate: Thu, 03 Jan 2019
Source: Wall Street Journal (US)
Copyright: 2019 Dow Jones & Company, Inc.
Author: Arian Campos-Flores


There is a new tool to help battle the opioid epidemic that works like
a pregnancy test to detect fentanyl, the potent substance behind the
escalating number of deaths roiling communities around the country.

The test strip, originally designed for the medical profession to test
urine, can also be used off-label by heroin and cocaine users who fear
their drugs have been adulterated with the synthetic opioid fentanyl.
The strips are dipped in water containing a minute amount of a drug
and generally provide a result within a minute-with one line
indicating positive for fentanyl, and two lines negative.

Overdose-prevention organizations in the U.S. first started buying and
handing out fentanyl test strips about two years ago, and they caught
on quickly. Now, states like California and Rhode Island and cities
such as Baltimore, Philadelphia and Columbus, Ohio, are distributing
them, or plan to soon.

"This is an effective way to have people thinking about risks," said
Louise Vincent, executive director of the Greensboro, N.C., chapter of
the advocacy group Urban Survivors Union, which has been distributing
strips since last year. "It's so important to give people as many
tools as we can."

The moves have encountered opposition. Elinore McCance-Katz, head of
the federal government's Substance Abuse and Mental Health Services
Administration, said the approach relied on the flawed premise that
drug users would make rational choices. She also said the strips
aren't guaranteed 100% accurate.

"We can't afford to create a false sense of security" for users, Dr.
McCance-Katz wrote on the agency's blog in October. "Let's not
rationalize putting tools in place to help them continue their
lifestyle more 'safely.' "

Groups that work with drug users say the strips provide an additional
means of saving lives, along with distributing overdose-reversal drug
naloxone and clean needles. And they create another way to engage
users and potentially steer them to treatment programs.

Several studies published this year suggest test strips could alter
drug users' behavior. Among a group of users who tested such drugs as
cocaine, heroin and prescription painkillers with the strips, half got
at least one positive result, according to a study published in
November by researchers at Brown University and other institutions.
Among those, 45% responded by using smaller amounts of the drug, 42%
ingested it more slowly and 36% did a test hit before taking a full

Many of the advocacy organizations use fentanyl test strips made by
Canadian biotechnology company BTNX Inc., and their sales have soared
in the U.S., reaching 766,000 strips so far this year, compared with
117,000 in 2017, said Chief Executive Iqbal Sunderani. The cost: $1 a

The company first began selling the strips in 2013 to doctors in
Canada, who needed to ensure that patients who were prescribed
fentanyl to treat severe pain were taking the medication. Three years
later, a supervised drug-injection facility in Vancouver began using
the strips to test illicit drugs.

A study published in February by Johns Hopkins Bloomberg School of
Public Health found that BTNX strips were highly accurate, detecting
fentanyl successfully 96% of the time at one lab and 100% of the time
at another. Mr. Sunderani said the strips also can detect at least 10
fentanyl analogues, or chemical cousins, including

The strips aren't approved by the U.S. Food and Drug Administration.
While they could fall under state drug-paraphernalia laws that usually
ban the use of testing equipment, there isn't settled case law on the
issue, said Lindsay LaSalle, director of public health law and policy
at the Drug Policy Alliance. Some jurisdictions, including Maryland
and Rhode Island, have passed measures making test strips legal.

Early adopters of fentanyl test strips in the U.S. were harm-reduction
groups, which provide services like counseling and needle exchanges.
Jess Tilley, who works with drug users in Massachusetts, started
handing them out about two years ago and found an eager response.

"It spread like wildfire," she said.

Elaine, a 45-year-old heroin and cocaine user in Holyoke, Mass., who
declined to give her last name, said she gets about 50 strips a month
from Ms. Tilley and hands some out to friends. If she gets a positive
result, she said, she uses only a small amount of the drug and makes
sure she has someone present.

"It's vital that I have the strips," she said.
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