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Georgea Kovanis: New $1 test prevents overdose deaths, but Michigan doesn't have many

Detroit Free Press - 1/5/2019

Jan. 05--A new test that tells drug users whether heroin, cocaine or other street drugs are laced with super deadly fentanyl is getting publicity as a major weapon in the fight against drug overdose deaths, though it has yet to be used widely in Michigan.

Fentanyl test strips, which sell for $1 each and were developed by a Canadian company BTNX Inc., were initially used to detect drugs in urine. But dipped into drug residue left in a heroin cooker or plastic bag from cocaine that's been mixed with a small amount of water, they can detect the presence of fentanyl and many of its analogs.

Up to 50 times more powerful than heroin, fentanyl is often cut into street drugs, unbeknownst to users. It is involved in more overdose deaths than any other illicit drug, according to the U.S. Centers for Disease Control and Prevention. Of the approximately 72,000 drug overdose deaths in the United States in 2017, about 50,000 were opioid-related. And of those, about 30,000 involved fentanyl.

In 2017, the State of California began paying needle exchange organizations to distribute the test strips. Public health departments in Philadelphia and Baltimore also provide the strips.

In 2018, BTNX sold 766,000 test strip kits to accounts in the United States. But only 1,200 ended up in Michigan, according to BTNX chief executive Iqbal Sunderani.

So why aren't more available here?

There are issues with funding and philosophy.

Just as it is not allowed to use federal funding to purchase needles for needle exchange programs, the State of Michigan is also not allowed to use federal funding for fentanyl test strips.

The Michigan Department of Health and Human Service encourages organizations to follow that guideline with money it receives from the State of Michigan, said Lynn Sutfin, spokeswoman for the Michigan Department of Public Health.

As a result, needle exchanges and other agencies need to secure private funding for fentanyl test strips. And private money doesn't always come easily.

"Funding is extremely limited through private resources to support services," Barbara Locke, director of prevention programs for Community Health Awareness Group in Detroit said in an email to the Free Press.

"These funds only allow us to cover the cost of harm reduction supplies ... clean sterile syringes and other materials, wound care supplies and other items that have allowed us to successfully prevent further spread of bloodborne diseases," she said. "The substantial demand for harm reduction services -- due to the opiate epidemic -- combined (with) limited funds have precluded us from purchasing items such as fentanyl test strips."

Lemont Gore, street outreach coordinator at Unified -- HIV Health and Beyond in Ypsilanti, has distributed some of the strips but doesn't believe he will replenish his organization's supply when it runs out.

"(The test strips are) a useful tool for those individuals who are currently using who are doubtful that there's fentanyl in the drugs they're using," Gore said. "For the most part, people that tried (the test) found fentanyl in their drugs. ... Once they establish that, there's no reason to keep testing."

Practicing harm reduction is what is necessary. "If you find fentanyl in your drugs ... there's fentanyl in 90 to 95 percent of the drugs being sold ... you either want to use around other people, make sure that someone else is present, make sure you have Narcan or naloxone present, probably use much slower than you might normally use and try to control that whole process as much as you can."

According to a Johns Hopkins University survey of 335 drug users, knowing there's fentanyl in street drugs makes a difference to users. Seventy percent of users surveyed said they would change their behavior -- not using the drugs, using the drugs more slowly, using the drugs with others who have Narcan, or buying drugs from different sources -- if they knew their drugs contained fentanyl.

Not everyone agrees with that assessment, however.

Dr. Elinore McCance-Katz, the U.S. assistant secretary for mental health and substance use, doesn't believe drug users have the ability to make rational decisions about their drug use.

In a blog post on the government's Substance Abuse and Mental Health Services Administration blog, she wrote:

"The entire approach is based on the premise that a drug user poised to use a drug is making rational choices, is weighing pros and cons, and is thinking completely logically about his or her drug use. Based on my clinical experience, I know this could not be further from the truth.

"People who are addicted to opioids are not making a rational choice to continue their drug use. Addicted individuals whose bodies demand that they find their next opioid to stave off withdrawal symptoms are not in positions to weigh all options and to choose to not use the only opioid at their disposal."

She did heroin with her mom, then found her dead

The strips are highly accurate at detecting fentanyl, according to the Johns Hopkins research.

And while they can detect several fentanyl analogs including carfentanil, the elephant tranqualizer which is 100 times stronger than fentanyl, it's possible there are other analogs it cannot detect.

Contact Georgea Kovanis: gkovanis@freepress.com or 313-222-6842.

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(c)2019 the Detroit Free Press

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