The unknown presence of fentanyl — an opioid fifty times stronger than heroin — in many drugs has contributed to the increasingly fatal opioid crisis that has swept across the United States in recent years. A new study co-authored by Traci Green, adjunct associate professor of emergency medicine and epidemiology at the University, and Susan Sherman, professor of health, behavior and society at Johns Hopkins University, has shown that testing strips can be used to detect trace amounts of fentanyl. The compact and cost-effective strips can be easily distributed and are nearly 100 percent accurate. Their work will allow agencies across the country to implement these tests in the near future.
“People are dying,” Sherman said. “We wanted to understand the nature of these testing methods … (so) we could better (understand) what are the best ones to employ in the field.” The testing strips are especially advantageous due to their simplicity and low cost.
Drug checking can be helpful to start a conversation with an individual regarding safe drug use, Sherman said. “(The strip) brings us to a different kind of conversation about the reality of peoples’ drug use,” she added.
Expanding the use of the strips could benefit initial advancements in public health programs combating the epidemic. The majority of public health services are located in urban environments, but expanding harm reduction services to non-urban and younger populations is vital to reaching the shifting demographics of users, Green said. The strips will make it easier for agencies to reach people in these areas, she added.
Although these strips can be seen as a means of initial treatment, their use is one of the last steps in the process. “It’s not all about treatment. Getting someone housing and getting their kids back, … that would go farther than getting people into treatment,” Sherman said. “The point is to keep them alive.”
While the strips test opioids and are meant to combat the epidemic, they may provide insight applicable to fighting future drug epidemics as well. “This could be really useful across the board for any drug supply. … If we indeed had a larger problem with another drug it would be a way to help us lose risk and increase health services,” Green said.
Health agencies currently use other methods to check drug quality, including spectrometry, a method less sensitive than the strips but one that leads to a more detailed analysis, Green and Sherman said. However, spectrometry requires a physical space to conduct tests, while the strips are more mobile. While the strips were the most sensitive of the three forms of testing studied by Green and Sherman, they do not discern between analogs of fentanyl or analyze its concentration.
Drug checking is mainly conducted in Europe, but the strips were first piloted in Canada and in limited areas across the United States. Recently, California has bought thousands of the strips tested by Sherman and Green to use in their public health programs, Green said. The demographics of opioid users today are different from those who used the drugs many years ago. “Drug checking is one thing that could help us reach populations who perhaps haven’t been thinking about their risk of opioid use,” Green added.
Silvia Martins, associate professor of epidemiology at Columbia University who is unaffiliated with the study, said the epidemic started many years ago despite its recent attention. “The opioid epidemic started in the late 1990s and occurred in parallel with an increase of prescription opioid use in the (United States),” she said. Martins noticed little research and few papers about increasing opioid prescription and use and decided to enter this line of research in 2004. “People weren’t paying that much attention. … Once it began affecting suburban whites, it became a big issue. … Once it started affecting middle-class white people, it started gaining attention,” she added.
Alongside the recent implementation of the testing strips, places such as New York City, Seattle, Kentucky and others across the country are creating health campaigns and increasing training to raise awareness of opioid overdoses. In addition, the Center for Disease Control and Prevention has partnered with physicians to monitor and alter prescription practices to limit opioid possession. “The next big step needs an intertwined solution at a different level, making sure that all major cities and suburban areas have these prevention programs,” Martins said. Furthermore, raising the awareness of family members and the general public to lessen the stigma of opioid overuse is necessary, alongside a data-driven, multi-pronged approach, she added.