In its ongoing fight against a fentanyl-fueled surge in drug overdoses, the Baltimore City Health Department plans to study the efficacy of test strips that detect the potent synthetic substance in street-purchased drugs by handing kits out at mobile syringe and needle exchanges.
The study will evaluate the outcomes of BTNX Rapid Response Urine Test strips “as a harm reduction strategy to reduce the negative consequences associated with drug use,” according to city spending board documents from this week.
Health care providers, researchers, advocates and users are increasingly looking to BTNX strips–traditionally a tool for employers to detect drug use among recruits and workers– to test for the presence of fentanyl in street-bought drugs. Instead of dipping the strip into someone’s urine, one can dissolve some of the illicit drugs into water and use the test to determine whether or not it contains fentanyl. A line will appear if it detects any amount.
The city plans to pay just shy of $48,000 to Ontario-based BTNX for the strips, drawing the funds from a grant provided by the Open Society Institute-Baltimore, according to the health department. The expense goes for Board of Estimates approval Wednesday morning.
If approved, the department will begin distributing the tests to users from its vans that serve as mobile needle and syringe exchanges.
“These strips will be distributed in settings where there is time to have a conversation with the recipient about their use and where recipients will return on a recurring basis so that they can provide feedback,” the health department said in an emailed statement.
Fentanyl, a synthetic opioid 50 times stronger than heroin, according to the U.S. Drug Enforcement Administration, has accounted for a growing share of overdoses in Baltimore and across Maryland as drug dealers and suppliers have cut it into their product to boost potency.
The department’s statement noted fentanyl-related deaths in Baltimore climbed from just 12 in 2013 to nearly 600 in 2017. Preliminary state figures also indicate that of the 653 drug and alcohol intoxication deaths that happened in Maryland from January through March of this year, 500 were fentanyl-related. Among those, 207 occurred in Baltimore City, a 68 percent jump from the first quarter of 2017.
The growing ubiquity of fentanyl has left many users in fear that they’ll ingest an overdose-inducting batch of illicit drugs. A 2017 study by researchers from Johns Hopkins University’s Bloomberg School of Public, Brown University and other institutions found 84 percent of drug users surveyed in Baltimore, Boston and Providence, Rhode Island, were concerned about the presence of fentanyl in the drugs they use.
In a story for the Baltimore Beat this past winter, Baynard Woods interviewed a former heroin dealer and user who was helping local users test for the more potent substance. What he was doing was illegal, he admitted—physically holding drugs to test them counts as possession, and the strips fell under the definition of paraphernalia—but he countered, “I’m not going to sit back and wait for the law to change or the government to help, because they ain’t never helped me and the law ain’t either.”
A growing list of jurisdictions are giving this a shot, however. Vancouver, British Columbia, first developed strip-testing protocol in one of its pioneering safe injection sites, and other cities in the U.S., including San Francisco, Philadelphia, Cleveland and, most recently, Burlington, Vermont, have begun offering the strips at no cost to users. California is also paying dozens of needle exchanges to distribute the test strips.
And while the Beat story noted using them was technically illegal at the time, state policy has since changed. A new Maryland law, proposed by outgoing Baltimore state Sen. Joan Carter Conway and enacted in April, included language to exempt “equipment used to test or analyze a controlled dangerous substance” from the definition of paraphernalia, effectively legalizing the use of such strips.
The 2017 study found the strips “had the lowest detection limit and the highest sensitivity and specificity for fentanyl,” and managed to detect it in samples in which the higher-tech tools did not.
The strips are not foolproof, the study noted, given the potential for false positives or negatives in testing, and the chance that “other toxic contaminants may go undetected.”
Health Commissioner Dr. Leana Wen has gone on the record cautioning against the practice of handing them out to users, citing the potential for false readings and the potential presence of pure heroin or cocaine that could cause an overdose anyway.
“The last thing I want for people to do is to test a supply of drugs, see that it’s negative for fentanyl and assume that it’s safe,” Wen told McClatchy earlier this year. She called for more evidence-based research to prove the safety and efficacy of such testing.
Asked for comment on Wen’s earlier remarks in light of the decision to begin distributing the strips, a department spokesperson said, “This is a study. It is to obtain data on efficacy in Baltimore.”
The department also noted in an email that “BCHD continues to provide their clients harm reduction tools, offers trainings with access to naloxone, and connections to addiction treatment.”
Wen has championed naloxone, the overdose-reversing medication, in her time as health commissioner, urging Baltimoreans to receive training in administering it, and by making the drug available over the counter at pharmacies.
The 2017 study found that “drug checking” offered some assurance to surveyed users about what they’re ingesting, and could push them to modify their use behavior. Among 335 surveyed users, 70 percent said knowing their drugs contained fentanyl would push them to modify how they use.
“This could include not using the drugs, using the drugs more slowly, or using the drugs with others who have naloxone, as well changing their purchasing behaviors,” it said.
Eighty-nine percent of those surveyed agreed drug checking “would make them feel better about protecting themselves from overdose,” the study found.