Drug overdoses are now officially the leading cause of death in Americans under 50, according to a report compiled by the New York Times last month. The data suggests that overdose deaths likely exceeded 59,000 last year, the largest annual jump ever recorded in the United States. Many of those deaths were due to the synthetic opioid fentanyl, which is 50 times more potent than heroin and 100 times stronger than morphine.
"Personally, I've had multiple friends die already this year, and an overwhelming majority of those cases involve fentanyl, carfentanil—all the synthetics," says Sean Horveath, who is currently recovering from heroin addiction and now works in the addiction treatment industry. Especially in southern Florida, where he moved after growing up in the northeast, Horveath says that fent is "absolutely wreaking havoc."
"I actually was thinking about it the other day: Wouldn't it be nice if they came out with something that was accessible so that you could easily test how much fentanyl was in something?" he asks.
As it turns out, there is something that lets you do that. Sort of, at least. In online forums, people have recently begun noting that the urine strips that test for fentanyl can be used to test drugs for the substance before you use, too. The way it works is, someone can mix a bit of the drug (the powder or a pill crushed to powder) with water and test that. At St. Ann's Corner of Harm Reduction, a rehab facility in the Bronx, syringe access program manager Van Asher is behind an experimental initiative that offers users these rapid response strips to check their stash of whatever people mean to ingest for the presence of the synthetic opioid that they don't.
"I've had people come in and say, 'Oh my god, last night I copped somewhere that I usually don't, and I tested it and it said positive, and I just did a little and almost overdosed. I'm convinced I would've died if I didn't have it,'" Asher says. It's a report he's gotten multiple times since the program debuted about eight months ago.
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Asher is trying to collect additional data, too. Along with each test, he hands clients a questionnaire: At which cross street were the drugs purchased? Were they positive or negative for fentanyl? Did you use them anyway—and if so, did you use any differently? Was there an identifying stamp on the bag? What's surprising—since this could be misconstrued as snitching (and snitches end up in ditches)—is that people actually fill it out. The fact that it's anonymous and short helps.
The initiative at St. Ann's was the first of its kind in the United States, although a needle exchange in Vancouver called Insite was actually the first to introduce something like this last year. Asher is now collaborating with other needle exchanges around the country—from Connecticut to California to Texas—that have kicked off similar testing programs of their own.
And while the strips are also available online—which make them easy to obtain even if you don't visit a harm reduction center—it's not a perfect solution. There are multiple kinds of fentanyl, and the strips don't work on all of them. And Edward Boyer, an emergency room physician at Brigham and Women's hospital in Boston, explains that these tests have a validated set of study parameters—they're tuned to detect the presence of certain analytes in urine, specifically. And urine has chemicals in it that can impact how things bind. "Here's the problem with it," he says. "I don't know, and nobody can tell me, what effect that has on the binding of fentanyl to the antibody … and then to the chemical hardware that allows you to interpret the results of the test."
In other words, the chemical reaction that occurs to reveal a positive or negative result might not work. Each reaction is dependent on a number of factors; it requires a given amount of solute, certain temperatures, a specific concentration of the drug.
"Unless all those things are done, you don't have confidence about whether the study is accurate or not. It's easy to get false negatives," Boyer adds. "If you think that it's worth your life to say, 'Maybe it reacts, I hope so,' then go right ahead. But I'm not about to start using it in the hospital."
At St. Ann's, Asher hands out cards with each test explaining that a negative reading could mean the drug contains a different fentanyl analogue that isn't coming up positive and that regardless of the result, there's no guarantee that it's the drug you paid for. And he notes that it's true, the strips are not FDA approved—yet. He tells me that researchers at Johns Hopkins have launched a formal study of the strips.
Horveath notes that while he thinks that having a quick way to test for fentanyl is definitely valuable, he's not sure that drug users will take the time people or put in the effort to obtain or take the tests. "I can say that when you're in the state of mind that you're using heroin, you're probably not going to go out of your way to get something like this unless it's free and it's very easily accessible," he says. "It seems like a no-brainer, but to actually go and get these and acquire them—whether they cost anything or not—it's an extra step in the way of achieving that feeling that you want to feel."
Asher doesn't see it that way. "If that were true—that drug users don't care about their health—then we wouldn't have seen the HIV rate go down from 54 percent in the early '90s among the over quarter-million injectors in New York to under 3 percent, where it's held once sterile syringes were made available," he says. People want to feel the effects of their hit but they don't want to die, he adds.
And, imperfect solution or not, treatment experts like Horveath see how programs like this are way better than nothing. In Florida, especially, he's watched as his friends—some of them transplants from other states who were unaccustomed to synthetics in heroin—end up hospitalized or dead after using just once down south. "Anything that you can do to keep somebody safe is obviously a good thing. If that's the key that we can figure out to saving people's lives right now, then I'm all for it," he says.